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Send us a textDescription: An immersive reading of A Hymn to God the Father by John Donne with reflection on medical errors and confession. Website:https://anauscultation.wordpress.comWork:A Hymn to God the Father by John DonneWilt thou forgive that sin where I begun,         Which was my sin, though it were done before?Wilt thou forgive that sin, through which I run,         And do run still, though still I do deplore?                When thou hast done, thou hast not done,                        For I have more.Wilt thou forgive that sin which I have won         Others to sin, and made my sin their door?Wilt thou forgive that sin which I did shun         A year or two, but wallow'd in, a score?                When thou hast done, thou hast not done,                        For I have more.I have a sin of fear, that when I have spun         My last thread, I shall perish on the shore;But swear by thyself, that at my death thy Son         Shall shine as he shines now, and heretofore;                And, having done that, thou hast done;                        I fear no more.References:Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000 Mar 18;320(7237):726-7. doi: 10.1136/bmj.320.7237.726. Finkelstein A, Brezis M, Taub A, Arad D. Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives. Isr J Health Policy Res. 2024 Mar 11;13(1):13.Rodziewicz TL, Houseman B, Vaqar S, et al. Medical Error Reduction and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000. PMID: 25077248.

In this episode, I make a brave confession and explore how Terrifier (2016) reflects the psychological phenomenon of imposter syndrome.Mental Health is Horrifying is hosted by Candis Green, Registered Psychotherapist and owner of Many Moons Therapy...............................................................Show Notes:Join Out Of The Broom Closet if you would like to move from shame to pride in claiming your identity as a witch, and confidently step out of the broom closet. This course includes psychoeducation about shame, trauma, and exile within our cultural context, and witch-positive exercises to connect with your authentic self including tarot, journaling, spellwork, and creative visualization. Want to work together? I offer 1:1 psychotherapy (Ontario), along with tarot, horror, and dreamwork services, both individually and through my group program, the Final Girls Club. Podcast artwork by Chloe Hurst at Contempo MintTerrifier 2025 ConferenceHuecker MR, Shreffler J, McKeny PT, Davis D. Imposter Phenomenon. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 36251839.

In this episode, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray dive into a critical case involving a five-week-old baby facing acute respiratory failure due to pertussis. They chat about how this condition shows up, how it's diagnosed, and the best ways to manage it, especially considering the serious complications it can cause in infants, like pulmonary hypertension and the potential need for ECMO. The conversation underscores the importance of catching it early and providing supportive care, while also highlighting how crucial vaccination is in preventing pertussis. Tune in to learn how severe this disease can be and why staying alert in pediatric care is so important.Show Highlights:Clinical case of a five-week-old infant with acute respiratory failure and pertussis diagnosisEpidemiology and public health impact of pertussis, including vaccination rates and outbreak patternsPathophysiology of pertussis and its effects on respiratory health, particularly in infantsClinical presentation of pertussis, including stages of the disease and atypical symptoms in infantsDiagnostic approaches for pertussis, including laboratory findings and PCR testingManagement strategies for severe pertussis, including supportive care and antibiotic therapyPotential complications associated with pertussis, especially in young infantsDifferential diagnosis considerations for pertussis and distinguishing features from other infectionsImportance of vaccination in preventing pertussis and reducing morbidity and mortalityECMO as a treatment option for severe cases and its associated challenges, and outcomesWe welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.References:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter and Rogers texbook of Pediatric intensive care -both do not have any Pertussis mentioned in their index.Rowlands HE, Goldman AP, Harrington K, Karimova A, Brierley J, Cross N, Skellett S, Peters MJ. Impact of rapid leukodepletion on the outcome of severe clinical pertussis in young infants. Pediatrics. 2010 Oct;126(4):e816-27. doi: 10.1542/peds.2009-2860. Epub 2010 Sep 6. PMID: 20819895.Lauria AM, Zabbo CP. Pertussis. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519008/Berger JT, Carcillo JA, Shanley TP, Wessel DL, Clark A, Holubkov R, Meert KL, Newth CJ, Berg RA, Heidemann S, Harrison R, Pollack M, Dalton H, Harvill E, Karanikas A, Liu T, Burr JS, Doctor A, Dean JM, Jenkins TL, Nicholson CE; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Critical pertussis illness in children: a multicenter prospective cohort study. Pediatr Crit Care Med. 2013 May;14(4):356-65. doi: 10.1097/PCC.0b013e31828a70fe. PMID: 23548960; PMCID: PMC3885763.Cousin, V.L., Caula, C., Vignot, J. et al. Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score. Crit Care 29, 71 (2025). https://doi.org/10.1186/s13054-025-05300-2Domico M, Ridout D, MacLaren G, Barbaro R, Annich G, Schlapbach LJ, Brown KL. Extracorporeal Membrane Oxygenation for Pertussis: Predictors of Outcome Including Pulmonary Hypertension and Leukodepletion. Pediatr Crit Care Med. 2018 Mar;19(3):254-261. doi:...

Understanding HIV and AIDS, including HIV virology, epidemiology as well as HIV symptoms (including WHO clinical classification and CDC CD4 count classification). Also covered is diagnosis and treatment including anti retroviral therapy (ART). Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is HIV? 0:28 HIV Microbiology1:36 HIV Pathophysiology2:17 HIV Epidemiology3:17 HIV Symptoms & Clinical Stages6:25 HIV Diagnosis8:00 HIV TreatmentReferencesBMJ Best Practice (2025) - “HIV in adults”. Available at https://bestpractice.bmj.com/topics/en-gb/555Mpiko Ntsekhe, MD, PhD and Jason V. Baker, MD, MSc (2022) - “Cardiovascular Disease Among Persons Living With HIV: New Insights Into Pathogenesis and Clinical Manifestations in a Global Context”. Available at https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.057443Virology Research Services (2022) - “The Virus of the Month - HIV”. Available at https://virologyresearchservices.com/2022/09/04/the-virus-of-the-month-hiv/Waymack JR, Sundareshan V. Acquired Immune Deficiency Syndrome. [Updated 2023 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available at https://www.ncbi.nlm.nih.gov/books/NBK537293/Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition. Geneva: World Health Organization; 2016. ANNEX 10, WHO clinical staging of HIV disease in adults, adolescents and children. Available at https://www.ncbi.nlm.nih.gov/books/NBK374293/fVirtual Mentor. 2010;12(3):202-206. doi: 10.1001/virtualmentor.2010.12.3.cprl1-1003. Available at https://journalofethics.ama-assn.org/article/who-clinical-staging-system-hivaids/2010-03Please remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

Send us a textDescription: An immersive reading of Thoughts by Myra Viola Wilds with reflection on psychotherapy, meditation, cognitive behavioral therapy and vision loss. Website:https://anauscultation.wordpress.comWork: Thoughts by Myra Viola Wilds   In your travels day by dayAre they bright and lofty visions,    Or neglected, gone astray?Matters not how great in fancy,     Or what deeds of skill you've wrought; Man, though high may be his station,     Is no better than his thoughts. Catch your thoughts and hold them tightly,    Let each one an honor be; Purge them, scourge them, burnish brightly,    Then in love set each one free.References:Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/(2025, March 5). Overview - Cognitive behavioural therapy (CBT). nhs.uk. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/ 

You might think that neck pain after minor trauma is probably a musculoskeletal injury.  But do not forget to consider vertebral artery dissection.     Check out the Stat Pearls page. Britt TB, Agarwal S. Vertebral Artery Dissection. [Updated 2023 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441827/    www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

It is important to check peripheral neurology after trauma.  Neurapraxia, with an o, is one cause of altered sensation.     Check out the Stat Pearls Page for more information. Carballo Cuello CM, De Jesus O. Neurapraxia. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560501/ And their table outlining the classifications Biso GMNR, Munakomi S. Neuroanatomy, Neurapraxia. [Updated 2022 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. [Figure, Seddon and Sunderland Classification of Nerve Injury Contributed by GMN Biso, MD] Available from: https://www.ncbi.nlm.nih.gov/books/NBK557746/figure/article-25766.image.f1/   And the Wikipedia page on Obdormition       www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

In this episode, Melanie talks about a rare congenital condition called medullary sponge disease (MSD) or medullary sponge kidney (MSK) and how people with the disease CAN still prevent kidney stones!  Garfield K, Leslie SW. Medullary Sponge Kidney. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470220/    Submit a question for Melanie to answer on the podcast! Connect with The Kidney Dietitian! Work with Us! |  Instagram | Facebook | Pinterest | Facebook Group | Newsletter www.thekidneydietitian.org All information in this podcast is meant for educational purposes only and should not be used in place of advice from a medical professional.  

Type 2 diabetics can present with a DKA associated with SGLT-2 inhibitors.  And it may be euglycaemic.  So be wary.     Check out the Prescriber Update, Vol 45, No 4, Dec 2024 Check out the Stat Pearls page on DKA Lizzo JM, Goyal A, Gupta V. Adult Diabetic Ketoacidosis. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560723/    www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

We should be familiar with Reye Syndrome and its association with aspirin. Check out the Stat Pearls page Chapman J, Arnold JK. Reye Syndrome. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526101/    Check out the original Reye paper REYE RD, MORGAN G, BARAL J. ENCEPHALOPATHY AND FATTY DEGENERATION OF THE VISCERA. A DISEASE ENTITY IN CHILDHOOD. Lancet. 1963 Oct 12;2(7311):749-52. doi: 10.1016/s0140-6736(63)90554-3. PMID: 14055046.      www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

In this episode, we explore the critical role nurses play in advancing health equity within the ICU. Jennifer Adamski, president of the American Association of Critical-Care Nurses, shares insights on how nurses can make a difference at the bedside and the challenges they face. We also discuss strategies for empowering nurses and fostering a culture of equity in critical care.This episode is sponsored by Medtronic.Areia C, King E, Ede J, Young L, Tarassenko L, Watkinson P, Vollam S. Experiences of current vital signs monitoring practices and views of wearable monitoring: A qualitative study in patients and nurses. Journal of advanced nursing. 2022 Mar;78(3):810-22Williams EC, Polito V. Meditation in the Workplace: Does Mindfulness Reduce Bias and Increase Organisational Citizenship Behaviours? Front Psychol. 2022 Apr 11;13:747983. doi: 10.3389/fpsyg.2022.747983. PMID: 35478759; PMCID: PMC9035788.Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook. 2023 Sep-Oct;71(5):102032. doi: 10.1016/j.outlook.2023.102032. Epub 2023 Sep 6. PMID: 37683597.Bhavani SV, Wiley Z, Verhoef PA, Coopersmith CM, Ofotokun I. Racial Differences in Detection of Fever Using Temporal vs Oral Temperature Measurements in Hospitalized Patients. JAMA. 2022;328(9):885–886. doi:10.1001/jama.2022.12290P Malhotra, L Shaw, J Barnett, E Hayter, N Hill, P Stockton. St Helens and Knowsley. P179 Patient safety alert: a prospective study on 100 patients highlighting inaccuracy of pulse oximeter finger probes used on ear lobes. Teaching Hospitals NHS Trust, Prescot, UK. 10.1136/thorax-2018-212555.336Torp KD, Modi P, Pollard EJ, Simon LV. Pulse Oximetry. 2023 Jul 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29262014Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Med Devices (Auckl). 2014 Jul 8;7:231-9. doi: 10.2147/MDER.S47319. PMID: 25031547; PMCID: PMC4099100Giuliano KK, Bilkovski RN, Beard J, Lamminmäki S. Comparative analysis of signal accuracy of three SpO2 monitors during motion and low perfusion conditions. J Clin Monit Comput. 2023 Dec;37(6):1451-1461. doi: 10.1007/s10877-023-01029-x. Epub 2023 Jun 2. PMID: 37266709; PMCID: PMC10651546Gudelunas MK, Lipnick M, Hendrickson C, et al. Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study. Anesth Analg. 2024;138(3):552-561. doi:10.1213/ANE.0000000000006755

Do you palpate for the epitrochlear lymph node?   Check out the papers mentioned Selby CD, Marcus HS, Toghill PJ. Enlarged epitrochlear lymph nodes: an old physical sign revisited. J R Coll Physicians Lond. 1992 Apr;26(2):159-61. PMID: 1588523; PMCID: PMC5375540. https://pmc.ncbi.nlm.nih.gov/articles/PMC5375540/    Catalano O, Nunziata A, Saturnino PP, Siani A. Epitrochlear lymph nodes: Anatomy, clinical aspects, and sonography features. Pictorial essay(). J Ultrasound. 2010 Dec;13(4):168-74. doi: 10.1016/j.jus.2010.10.010. Epub 2010 Nov 18. PMID: 23397026; PMCID: PMC3553226.  https://pmc.ncbi.nlm.nih.gov/articles/PMC3553226/    Pannu AK, Prakash G, Jandial A, Kopp CR, Kumari S. Epitrochlear lymphadenopathy. Korean J Intern Med. 2019 Nov;34(6):1396. doi: 10.3904/kjim.2018.218. Epub 2018 Dec 6. PMID: 30514055; PMCID: PMC6823563. https://pmc.ncbi.nlm.nih.gov/articles/PMC6823563/   Freeman AM, Matto P. Lymphadenopathy. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513250/        www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Weight loss medications are a hot topic.  But what are they? Who do they help and how? Join Mindy and Cheryl as they start a conversation about GLP-1 medications.  Mindy gives us her thoughts and client experience as a Registered Dietitian.  Our guest, Erika, shares her story. Listen to hear how these medications helped her on her journey (for reasons you may not have considered) and why she is no longer taking them. Erika‘s inspiring story reminds us that often life is not one size fits Article Mindy references:Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK551568/We are so glad you are here. Want to stay in touch?Follow us on social media: Mindy - @strongover40_dietitian Cheryl - @training.with.cheryl Mindy & Cheryl - @mcfitadventures Email us: mcfitadventures@gmail.com Thank you so much for listening to Sweat & Laughter. M & C

Medical errors are a common cause of harm to patients. In this episode of Critical Incident from Knowledgeable Provider, Jody recalls some of his own errors in the hope of encouraging all medical professionals to be honest and transparent about mistakes. References: 1) Rodziewicz TL, Houseman B, Vaqar S, et al. Medical Error Reduction and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/ 2) Kimberly N. Williams, Crystal M. Fausett, Elizabeth H. Lazzara, Yuval Bitan, Anthony Andre, Joseph R. Keebler, Investigative approaches: Lessons learned from the RaDonda Vaught case, Human Factors in Healthcare, Volume 4, 2023, 100054, ISSN 2772-5014, https://doi.org/10.1016/j.hfh.2023.100054. 3) Newman-Toker DE, Nassery N, Schaffer AC, et alBurden of serious harms from diagnostic error in the USABMJ Quality & Safety 2024;33:109-120. 4) Makary M A, Daniel M. Medical error—the third leading cause of death in the US BMJ 2016; 353 :i2139 doi:10.1136/bmj.i2139

What is a Felon and what should we do about it?   Check out the papers and pages mentioned. Nardi NM, McDonald EJ, Syed HA, et al. Felon. [Updated 2024 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430933/  Orthobullets page by Leah Ahn MD Koshy JC, Bell B. Hand Infections. J Hand Surg Am. 2019 Jan;44(1):46-54. doi: 10.1016/j.jhsa.2018.05.027. Epub 2018 Jul 14. PMID: 30017648. Clark DC. Common acute hand infections. Am Fam Physician. 2003 Dec 1;68(11):2167-76. PMID: 14677662. https://pubmed.ncbi.nlm.nih.gov/14677662/  Tannan SC, Deal DN. Diagnosis and management of the acute felon: evidence-based review. J Hand Surg Am. 2012 Dec;37(12):2603-4. doi: 10.1016/j.jhsa.2012.08.002. PMID: 23174075. Proegler C. The Panaritium (Felon)-Consequences and Treatment. Chic Med J. 1872 Nov;29(11):656-660. PMID: 37413177; PMCID: PMC9802920. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9802920/  Billroth T. Panaritium. Atlanta Med Surg J (1884). 1884 Mar;1(1):35-37. PMID: 35827592; PMCID: PMC8925372.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8925372/      www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Uncover the unexpected link between chronic inflammation, PCOS, and endometriosis. Learn actionable tips to manage it effectively and improve these hormonal disorders. You may be surprised how simple lifestyle changes can lead to improved symptom management and an overall better quality of life. We uncover how adopting an anti-inflammatory diet, exercise, stress coping strategies, and professional support can make a real difference in your hormonal health. There's a path forward, and you can start making a positive change today. In this episode, we: Discuss the two different types of inflammation and how they impact your body Explore inflammation's role in worsening PCOS and endometriosis features Discover effective strategies for managing chronic inflammation to better your health Episode links: PCOS Recovery Program Waitlist (available wordlwide) 1-on-1 Dietitian Nutrition Coaching Programs (available for Ontario and British Columbia residents) References: Aboeldalyl, S., James, C., Seyam, E., Ibrahim, E. M., Shawki, H. E.-D., & Amer, S. (2021). The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis. International Journal of Molecular Sciences, 22(5), 2734-. https://doi.org/10.3390/ijms22052734 Grassi, A. (2023). PCOS Nutrition Center. The Best Ways to Lower Inflammation for PCOS. https://www.pcosnutrition.com/lower-inflammation-for-pcos/ Helena Teede et al. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University. https://doi.org/10.26180/24003834.v1  Hussain, Y., Khan, H., Alotaibi, G., Khan, F., Alam, W., Aschner, M., Jeandet, P., & Saso, L. (2022). How Curcumin Targets Inflammatory Mediators in Diabetes: Therapeutic Insights and Possible Solutions. Molecules (Basel, Switzerland), 27(13), 4058-. https://doi.org/10.3390/molecules27134058 Pahwa R, Goyal A, Jialal I. Chronic Inflammation. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/ Rudnicka, E., Suchta, K., Grymowicz, M., Calik-Ksepka, A., Smolarczyk, K., Duszewska, A. M., Smolarczyk, R., & Meczekalski, B. (2021). Chronic Low Grade Inflammation in Pathogenesis of PCOS. International Journal of Molecular Sciences, 22(7), 3789-. https://doi.org/10.3390/ijms22073789 Rudnicka, E., Kunicki, M., Suchta, K., Machura, P., Grymowicz, M., & Smolarczyk, R. (2020). Inflammatory Markers in Women with Polycystic Ovary Syndrome. BioMed Research International, 2020, 4092470–10. https://doi.org/10.1155/2020/4092470 Shorakae, S., Ranasinha, S., Abell, S., Lambert, G., Lambert, E., de Courten, B., & Teede, H. (2018). Inter‐related effects of insulin resistance, hyperandrogenism, sympathetic dysfunction and chronic inflammation in PCOS. Clinical Endocrinology (Oxford), 89(5), 628–633. https://doi.org/10.1111/cen.13808 Helena Teede et al. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University. https://doi.org/10.26180/24003834.v1 

Episode 173: Acute OsteomyelitisFuture Dr. Tran explains the pathophysiology of osteomyelitis and describes the presentation, diagnosis and management of acute osteomyelitis. Dr. Arreaza provides information about    Written by Di Tran, MSIII, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is osteomyelitis?Osteomyelitis, in simple terms, is an infectious disease that affects both bone and bone marrow and is either acute or chronic.  According to archaeological findings of animal fossils with a bone infection, osteomyelitis was more than likely to be known as a “disease for old individuals”.Our ancestors over the years have used various vocabulary terms to describe this disease until a French surgeon, Dr. Nelaton, came up with the term “Osteomyelitis” in 1844. This is the beauty of medical terms, Latin sounds complicated for some people, but if you break up the term, it makes sense: Osteo = bone, myelo = marrow, itis = inflammation. So, inflammation of the bone marrow.Traditionally, osteomyelitis develops from 3 different sources:First category is the “hematOgenous” spread of the infection within the bloodstream, as in bacteremia. It is more frequent in children and long bones are usually affected. [Arreaza: it means that the infection started somewhere else but it got “planted” in the bones]Second route is “direct inoculation” of bacteria from the contiguous site of infection “without vascular insufficiency”, or trauma, which may occur secondary to fractures or surgery in adults.  In elderly patients, the infection may be related to decubitus ulcers and joint replacements.And the third route is the “contiguous” infection “with vascular insufficiency”, most seen in a patient with a diabetic foot infection.Patients with vascular insufficiency often have compromised blood supply to the lower extremities, and poor circulation impairs healing. In these situations, infection often occurs in small bones of the feet with minimal to no pain due to neuropathy.They can have ulcers, as well as paronychia, cellulitis, or puncture wounds.Thus, the importance of treating onychomycosis in diabetes because the fungus does not cause a lot of problems by itself, but it can cause breaks in the nails that can be a port of entry for bacteria to cause severe infections. Neuropathy is an important risk factor because of the loss of protective sensation. Frequently, patients may step on a foreign object and not feel it until there is swelling, purulent discharge, and redness, and they come to you because it “does not look good.”Acute osteomyelitis often takes place within 2 weeks of onset of the disease, and the main histopathological findings are microorganisms, congested blood vessels, and polymorphonuclear leukocytes, or neutrophilic infiltrates.What are the bugs that cause osteomyelitis?Pathogens in osteomyelitis are heavily depended on the patient's age.  Staph. aureus is the most common culprit of acute hematogenous osteomyelitis in children and adults.  Then comes Group A Strep., Strep. pneumoniae, Pseudomonas, Kingella, and methicillin-resistant Staph. aureus.  In newborns, we have Group B Streptococcal. Less common pathogens are associated with certain clinical presentations, including Aspergillus, Mycobacterium tuberculosis, and Candida in the immunocompromised.Salmonella species can be found in patients with sickle cell disease, Bartonella species in patients with HIV infection, and Pasteurella or Eikenella species from human or animal bites.It is important to gather a complete medical history of the patient, such as disorders that may put them at risk of osteomyelitis, such as diabetes, malnutrition, smoking, peripheral or coronary artery disease, immune deficiencies, IV drug use, prosthetic joints, cancer, and even sickle cell anemia. Those pieces of information can guide your assessment and plan.What is the presentation of osteomyelitis?Acute osteomyelitis may present symptoms over a few days from onset of infection but usually is within a 2-week window period.  Adults will develop local symptoms of erythema, swelling, warmth, and dull pain at the site of infection with or without systemic symptoms of fever or chills.Children will also be present with lethargy or irritability in addition to the symptoms already mentioned.It may be challenging to diagnose osteomyelitis at the early stages of infection, but you must have a high level of suspicion in patients with high risks. A thorough physical examination sometimes will show other significant findings of soft tissue infection, bony tenderness, joint effusion, decreased ROM, and even exposed bone. Diagnosis.As a rule of thumb, the gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathology findings and tissue culture. There is leukocytosis, but then WBC counts can be normal even in the setting of acute osteomyelitis.Inflammatory markers (CRP, ESR) are often elevated although both have very low specificity. Blood cultures should always be obtained whenever osteomyelitis is suspected.  A bone biopsy should also be performed for definitive diagnosis, and specimens should undergo both aerobic and anaerobic cultures.  In cases of osteomyelitis from diabetic foot infection, do the “probe to bone” test. What we do is we use a sterile steel probe to detect bone which is helpful for osteomyelitis confirmation.Something that we can't miss out on is radiographic imaging, which is quite important for the evaluation of osteomyelitis.  Several modalities are useful and can be used for the work-up plan; plain radiographs often are the very first step in the assessment due to their feasibility, low cost, and safety.  Others are bone scintigraphy, CT-scan, and MRI.  In fact, the MRI is widely used and provides better information for early detection of osteomyelitis than other imaging modalities.  It can detect necrotic bone, sinus tracts, and even abscesses. We look for soft tissue swelling, cortical bone loss, active bone resorption and remodeling, and periosteal reaction.  Oftentimes, plain radiography and MRI are used in combination. Treatment:Treatment of osteomyelitis actually is a teamwork effort among various medical professionals, including the primary care provider, the radiologist, the vascular, the pharmacist, the podiatrist, an infectious disease specialist, orthopedic surgeons, and the wound care team.Something to take into consideration, if the patient is hemodynamically stable it is highly recommended to delay empirical antibiotic treatment 48-72 hours until a bone biopsy is obtained.  The reason is that with percutaneous biopsy ideally done before the initiation of antibiotic treatment, “the microbiological yield will be higher”.We'll have a better idea of what particular bugs are causing the problem and guide the treatment appropriately. The choice of antibiotic therapy is strongly determined by susceptibilities results.  The antibiotic given will be narrowed down only for the targeted susceptible organisms.  In the absence of such information, or when a hospitalized patient presents with an increased risk for MRSA infection, empiric antibiotic coverage is then administered while awaiting culture results. It should be broad-spectrum antibiotics and include coverage for MRSA, broad gram-negative and anaerobic bacteria.  For example, vancomycin plus piperacillin-tazobactam, or with broad-spectrum cephalosporin plus clindamycin.  Treatment will typically be given for 4 to 6 weeks.The duration between 4-6 weeks is important for complete healing, but a small study with a small sample showed that an even shorter duration of 3 weeks may be effective, but more research is needed. In certain situations, surgery is necessary to preserve viable tissue and prevent recurrent infection, especially when there are deep abscesses, necrosis, or gangrene, amputation or debridement is deemed appropriate. If the infected bone is completely removed, patients may need a shorter course of antibiotics, even a few days only. Amputation can be very distressing, especially when we need to remove large pieces of infected bone, for example, a below-the-knee amputation. We need to be sensitive to the patient's feelings and make a shared decision about the best treatment for them.In patients with diabetes, additional care must be taken seriously, patient education about the need for compliance with treatment recommendations, with careful wound care, and good glycemic control are all beneficial for the healing and recovery process. Because this is a very common problem in the clinic and at the hospital, we must keep our eyes wide open and carefully assess patients with suspected osteomyelitis to detect it promptly and start appropriate treatment. Adequate and timely treatment is linked to fewer complications and better outcomes._________________________Conclusion: Now we conclude episode number 173, “Acute Osteomyelitis.” Future Dr. Tran explained the pathophysiology, diagnosis, and management of osteomyelitis. A bone biopsy is the ideal method of diagnosis. Delaying antibiotic treatment a few days until you get a biopsy is allowed if the patient is stable, but if the patient is unstable, antibiotics must be started promptly. Dr. Arreaza mentioned the implications of amputation and that we must discuss this treatment empathically with our patients. This week we thank Hector Arreaza and Di Tran. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Bury DC, Rogers TS, Dickman MM. Osteomyelitis: Diagnosis and Treatment. Am Fam Physician. 2021 Oct 1;104(4):395-402. PMID: 34652112.Cunha BA. Osteomyelitis in elderly patients. Clin Infect Dis. 2002 Aug 1;35(3):287-93. doi: 10.1086/341417. Epub 2002 Jul 11. PMID: 12115094.Fritz JM, McDonald JR. Osteomyelitis: approach to diagnosis and treatment. Phys Sportsmed. 2008 Dec;36(1):nihpa116823. doi: 10.3810/psm.2008.12.11. PMID: 19652694; PMCID: PMC2696389.Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011 Nov 1;84(9):1027-33. PMID: 22046943.Hofstee MI, Muthukrishnan G, Atkins GJ, Riool M, Thompson K, Morgenstern M, Stoddart MJ, Richards RG, Zaat SAJ, Moriarty TF. Current Concepts of Osteomyelitis: From Pathologic Mechanisms to Advanced Research Methods. Am J Pathol. 2020 Jun;190(6):1151-1163. doi: 10.1016/j.ajpath.2020.02.007. Epub 2020 Mar 16. PMID: 32194053.Momodu II, Savaliya V. Osteomyelitis. [Updated 2023 May 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532250/Royalty-free music used for this episode: Trap Chiller by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net 

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Antipsychotic Side Effects with our very own expert Dr Alex Raben, a staff psychiatrist in chronic care at the Centre for Addiction and Mental Health in Toronto. Dr. Raben graduated from medical school and completed residency at the University of Toronto. His academic interests include teaching and medical education scholarship with a particular interest in novel modalities of knowledge translation within the field of psychiatry. He is a founding member and Executive Director of PsychEd, this educational psychiatry podcast which aims to empower medical learners to seek out current knowledge from mental health experts to share with their colleagues around the world. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Outline the side effects of antipsychotics and their known/potential mechanisms Discuss management options for the different side effects Identify which antipsychotics are more likely to cause certain side effects Guest: Dr Alex Raben Hosts: Angad Singh and Kate Braithwaite Audio editing by: Angad Singh Show notes by: Angad Singh and Kate Braithwaite Interview Content: Introduction - 0:00 Primer on antipsychotics - 1:54 Anti-dopamine side effects - 5:04 Drug potency as it relates to side effects - 38:46 Anticholinergic side effects - 41:37 Antiadrenergic side effects - 47:30 Metabolic side effects - 50:29 Sedation - 56:46 Please note that this episode does not include a discussion of the life threatening side effects of antipsychotics. These include neuroleptic malignant syndrome, torsades de pointes, laryngospasm, and seizure. Resources: PsychEd Episode 10: Treatment of Schizophrenia Part II with Dr. Albert Wong — PsychEd Podcast PsychEd Episode 60: Metabolic Psychiatry with Dr. Cindy Calkin – Psyched Podcast AIMSExtendedSample - YouTube Anticholinergic Mnemonics: Toxicology Mnemonic Challenge • LITFL • Toxicology Conundrum References: de Silva VA, Suraweera C, Ratnatunga SS, Dayabandara M, Wanniarachchi N, Hanwella R. Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis. BMC psychiatry. 2016;16:1-0. Migirov A, Datta AR. Physiology, Anticholinergic Reaction. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546589/ Miller DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):3-7. PMID: 16001094; PMCID: PMC487011. Roerig JL, Steffen KJ, Mitchell JE. Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS drugs. 2011;25:1035-59. Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press; 2021. Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341-56. For more PsychEd, follow us on Instagram (@psyched.podcast), Twitter (@psychedpodcast), and Facebook (PsychEd Podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

If you're feeling exhausted from sifting through conflicting and often unhelpful diet advice for managing PCOS and IBS, constantly craving, experiencing digestive discomfort, and struggling to find relief from your symptoms, then you are not alone! In this episode of Joyful Eating with PCOS, Trista Chan, a registered dietitian and founder of the Good Life Dietitian, dives into the challenges faced by individuals dealing with PCOS and IBS. In this episode, we discuss: Discover how to manage PCOS and IBS through simple dietary changes. Uncover the power of supplements for improving PCOS and gut health. Explore the benefits of exercise for managing PCOS and IBS symptoms. Learn the art of mindful eating to balance your hormones and well-being. Understand the importance of quality sleep in effective PCOS management. Resources: PCOS Recovery Program https://www.thegoodlifedietitian.com/pcos-recovery-program Follow Trista and the team at https://www.instagram.com/thegoodlifedietitian/ References: Monash University. (2023). International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023. https://doi.org/10.26180/24003834.v1 Malone, J. C., & Thavamani, A. (2023). Physiology, gastrocolic reflex. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549888/ Manta, A., Paschou, S. A., Isari, G., Mavroeidi, I., Kalantaridou, S., & Peppa, M. (2023). Glycemic index and glycemic load estimates in the dietary approach of polycystic ovary syndrome. Nutrients, 15(15), 3483. https://doi.org/10.3390/nu15153483 Nunan, D., Cai, T., Gardener, A. D., Ordóñez-Mena, J. M., Roberts, N. W., Thomas, E. T., & Mahtani, K. R. (2022). Physical activity for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews, 2022(6), CD011497. https://doi.org/10.1002/14651858.CD011497.pub2 Fernandez, R. C., Moore, V. M., Van Ryswyk, E. M., Varcoe, T. J., Rodgers, R. J., March, W. A., Moran, L. J., Avery, J. C., McEvoy, R. D., & Davies, M. J. (2018). Sleep disturbances in women with polycystic ovary syndrome: Prevalence, pathophysiology, impact and management strategies. Nature and Science of Sleep, 10, 45-64. https://doi.org/10.2147/NSS.S127475799701.

Show Description: This week we discuss dreams. Our haunted location of the week features The Stanley Hotel of Estes Park, CO. Stay tuned for more episodes which release every other Friday! Thank you for listening! Ash Cliff Notes: Book: The Awakened Dreamer by Samantha Fay My email: ghostiegirlz@gmail.com My linktree Resources: Patel AK, Reddy V, Shumway KR, et al. Physiology, Sleep Stages. [Updated 2024 Jan 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526132/

Did you know that the treatments used to cure pediatric cancers can potentially cause a life-threatening event known as tumor lysis syndrome (TLS)? Arfa Ul-Haque and Yazmin Reategui, two third-year medical students, are joined by Pediatric intensivist, Dr. Smitha Mathew, to discuss the evaluation and management for TLS so that it is promptly recognized and treated in the inpatient hospital setting.   Specifically, they will:  Review the basic assessment skills and evaluation for a child presenting with potential TLS   Discuss the influence of chemotherapy, initial presentation, diagnostic options, and management of electrolyte imbalances found in TLS  Medications reviewed: daunorubicin, cytarabine, calcium gluconate, Rasburicase, allopurinol  Anticipatory guidance to medical professionals for potential onset of TLS  Special thanks to Dr. Eric Ring and Dr. Rebecca Yang for peer reviewing this episode. References: Tumor lysis syndrome. (2022, October 4). Medscape.com. https://emedicine.medscape.com/article/282171-overview Adeyinka A, Bashir K. Tumor Lysis Syndrome. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518985/ Cheung WL, Hon KL, Fung CM, Leung AKC. Tumor lysis syndrome in childhood malignancies. Drugs in Context 2020; 9: 2019-8-2. DOI: 10.7573/dic.2019-8-2 Cheung, Ho Hung MBBSa; She, Wong Hoi MBBSa,∗; Yap, Desmond Y.H. MDb; Tsang, Simon H.Y. MBChBa; Cheung, Tan To MDc. A case report of tumor lysis syndrome after stage-one ALPPS. Medicine 101(10):p e29040, March 11, 2022. | DOI: 10.1097/MD.0000000000029040 Flood, K., Rozmus, J., Skippen, P., Matsell, D. G., & Mammen, C. (2021). Fluid overload and acute kidney injury in children with tumor lysis syndrome. Pediatric Blood & Cancer, 68(12), e29255. https://doi.org/10.1002/pbc.29255 Barbar T, Jaffer Sathick I. Tumor Lysis Syndrome. Adv Chronic Kidney Dis. 2021 Sep;28(5):438-446.e1. doi: 10.1053/j.ackd.2021.09.007. PMID: 35190110. Adeyinka A, Bashir K. Tumor Lysis Syndrome. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518985/ Shenoy MT, D'Souza B, Akshatha LN, D'Souza V, Rajan MG. Spontaneous Tumor Lysis Syndrome in an Infant: A Case Report. Indian J Clin Biochem. 2015 Jul;30(3):360-2. doi: 10.1007/s12291-014-0472-y. Epub 2015 Feb 14. PMID: 26089626; PMCID: PMC4469048. Alakel N, Middeke JM, Schetelig J, Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther. 2017 Feb 2;10:597-605. doi: 10.2147/OTT.S103864. PMID: 28203093; PMCID: PMC5295804. Kollathodi SB, Parameswaran KK, Madhavan L, Kuruvilla S. Hematological malignancies presenting as spontaneous tumor lysis syndrome: A case series. J Family Med Prim Care. 2018 Sep-Oct;7(5):1116-1119. doi: 10.4103/jfmpc.jfmpc_171_18. PMID: 30598972; PMCID: PMC6259502.    

Бие Хүний Завсрын эмгэг нь бидний сэтгэл хөдлөл болон нөхцөл байдалд тохиромжтой хариу үйлдэл үзүүлэхэд доголдол үүсгэдэг эмгэг юм. Бие Хүний Завсрын эмгэг нь Borderline Personality Disorder хэмээн англи хэлнээ хөрвүүлэгддэг бөгөөд энэхүү сэтгэцийн эмгэгтэй хүмүүст сэтгэлзүйн хэт тогтворгүй байдал, огцом сэтгэл хөдлөлөө буруугаар илэрхийлэх мөн өөрийн дотоод мөн чанараа тодорхойлох чадварт нөлөөлдөг байна. Энэхүү эмгэг үүсэхэд олон хүчин зүйлс нөлөөлдөг бөгөөд бага насандаа сэтгэлзүйн болон бие махбодын хүчирхийлэлд өртөж байсан хүмүүс энэхүү эмгэгт өртөх боломж илүү байдаг байна. Нийгмийн амьдралд Бие Хүний Завсрын эмгэгтэй хүмүүс оролцоход хүндрэлтэй байдаг бөгөөд энэ нь тэдний хурц зан үйл мөн сэтгэл хөдлөлтэй холбоотой байна. Мөн нийгмийн сэтгэлзүйн эрүүл мэндийн мэдлэг дутмагаас болж олон хүмүүс эдгээр хүмүүсийг буруугаар ойлгож үүнээс болоод сэтгэцийн эмгэгтэй хүмүүс нийгэмд буруугаар ойлгогдох суур нь тавигддаг байна. Volunteer-оор орох сонирхолтой хүмүүс доорх линкээр орж application бөглөөрэй. Link: https://forms.gle/8tn8Dmx2bHNQFFrGA Бичвэрийн болон подкастын эх сурвалж:Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2023 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/Stone, M. H. (2000). Violence in adolescents : Background factors ; implications for treatment. Personality and Conduct Disorders, 175–192. https://doi.org/10.3917/greu.isap.2000.01.0175Kristalyn Salters-Pedneault, P. (2020, March 31). What are the genetic causes of borderline personality disorder?. Verywell Mind. https://www.verywellmind.com/genetic-causes-of-borderline-personality-disorder-425157Sun, C., Zhang, W., & Zhou, X. (2023). Causes and treatment of borderline personality disorder in light of genetic and environmental influences. Lecture Notes in Education Psychology and Public Media, 7(1), 492–500. https://doi.org/10.54254/2753-7048/7/2022905Fonagy, P., & Luyten, P. (2016). A multilevel perspective on the development of borderline personality disorder. Developmental Psychopathology, 1–67. https://doi.org/10.1002/9781119125556.devpsy317Schimelpfening, N. (2023, November 2). How dialectical behavior therapy (DBT) works. Verywell Mind. https://www.verywellmind.com/dialectical-behavior-therapy-1067402Linehan, M. M. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060. https://doi.org/10.1001/archpsyc.1991.01810360024003U.S. Department of Health and Human Services. (n.d.). Borderline personality disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/borderline-personality-disorderДэд сэдвүүд:0:00:00 - Эхлэл болон сэтгэцийн өвчний оношилгоо 0:02:38 - Бие хүний завсрын эмгэгийн тухай ойлголт0:08:26 - Онцлох шинж тэмдгүүд0:17:59 - BPD бидний амьдралд хэрхэн нөлөөлөх вэ?0:20:14 - BPD бий болоход ямар хүчин зүйлс нөлөөлдөг вэ?0:26:33 - BPD-ийн үед хийдэг эмийн болон эмийн бус эмчилгээ0:41:17 - Гэр бүл болон ойр дотны хүмүүсийн дэмжлэг хэр чухал вэ?0:43:28 - Сэтгэцийн яаралтай тусламж0:44:11 - Сайн дурын ажлын тухай зарлалBecome a supporter of this podcast: https://www.spreaker.com/podcast/podlogy-podcast--4323328/support.

The Ozempic episode is HERE (Part 1). By this point, most of us have heard of the celebrities taking Ozempic/ Wegovy. If not, you must not watch the news or be on social media...lucky you! These drugs are being called "a miracle" and the "end of the ob*sity epidemic". Is this true? Abbey is joined by her intern, Nicole, to discuss all things weight loss drugs. Together they cover: what Ozempic is, how it works for diabetes and for weight loss, the difference between Ozempic and Wegovy, common side effects, and more. There's a lot of discourse in this episode, so buckle up! TW: "ob*se and ov*rweight terms are used in the episode to describe the research and BMI qualifiers. Be sure to rate the podcast and subscribe! Join the Fork Diet Culture Community! Work with Abbey 1-on-1 More about Abbey Follow on IG and TT: @fork.diet.culture Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. [Updated 2023 Jan 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551568/ Shetty R, Basheer FT, Poojari PG, Thunga G, Chandran VP, Acharya LD. Adverse drug reactions of GLP-1 agonists: A systematic review of case reports. Diabetes Metab Syndr. 2022;16(3):102427. doi:10.1016/j.dsx.2022.102427 Kapoor I, Sarvepalli SM, D'Alessio D, Grewal DS, Hadziahmetovic M. GLP-1 receptor agonists and diabetic retinopathy: A meta-analysis of randomized clinical trials. Surv Ophthalmol. 2023;68(6):1071-1083. doi:10.1016/j.survophthal.2023.07.002 Suran M. As Ozempic's Popularity Soars, Here's What to Know About Semaglutide and Weight Loss. JAMA. 2023;329(19):1627-1629. doi:10.1001/jama.2023.2438 Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. doi:10.1111/dom.14725 Novo Nordisck. Ozempic. https://www.novocare.com/diabetes/products/ozempic.html Web site. Updated 2024 Gómez Lumbreras A, Tan MS, Villa-Zapata L, Ilham S, Earl JC, Malone DC. Cost-effectiveness analysis of five anti-obesity medications from a US payer's perspective. Nutr Metab Cardiovasc Dis. 2023;33(6):1268-1276. doi:10.1016/j.numecd.2023.03.012 Gordon A, Hobbs M. Maintenance Phase; Ozempic. 2023;Podcast

Dr.s Kay & Ray discuss themes from the first six episodes of Season 11 of Vanderpump Rules. They talk about all of the main castmates and their relationships with one another. At the end, Dr. Ray offers us a “Mental Health Check-Up” segment about narcissism. Reality testing is when we check an emotion or thought we're having against objective reality. So, here in Reality Test, we're going to be testing the thoughts, emotions, interactions, and producer antics of reality television against what we know, as licensed psychologists, about objective reality. Come Reality Test with us!References for the Mental-Health Check-up:American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596Herman, E. (2015). Narcissism and Its Discontents. Reviews in American History, 43(4), 723-728. 10.1353/rah.2015.0105Mitra, P., & Fluyau, D. (2021). Narcissistic Personality Disorder. 2021 May 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.  https://www.ncbi.nlm.nih.gov/books/NBK556001/Ronningstam, E. (n.d.). Narcissistic personality disorder: A basic guide for providers. Narcissistic Personality Disorder: Guide for Providers at McLean Hospital. https://www.mcleanhospital.org/npd-provider-guide#:~:text=NPD%20is%20diagnostically%20defined%20in,meet%20the%20diagnosis%20of%20NPD.Hosts: Dr. Kay & Dr. RayThank you to our sound extraordinaire, Connor!Email: realitycheckpodding@gmail.com

At the peak of respiratory virus season, bronchiolitis is one of the most common presentations in infants and young toddlers. The characteristic wheeze and prolonged duration of illness can be distressing for parents, who may lack the practical knowledge of how to effectively implement supportive care. When the mainstay of treatment is supportive care without any single curative intervention, you need to be able to discuss the etiology, management, and anticipatory guidance on a level that the parents can understand. This episode introduces the idea of capacity-building family-centered care and takes a granular, detailed approach to improving family understanding and home care education so that you can facilitate better evidence-based care in the unrestricted environment of the home. By arming parents with the knowledge and skills needed to care for their infant at home and the clear, objective return criteria, you're providing family-centered care and reducing unnecessary visits.    Instagram: @thepedsnppodcast Show notes and references thepedsnp.com Disclaimer   References Justice NA, Le JK. Bronchiolitis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441959/ Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., Azimi, P. H., Weinberg, G. A., Staat, M. A., Selvarangan, R., Halasa, N. B., McNeal, M. M., Klein, E. J., Harrison, C. J., Williams, J. V., Szilagyi, P. G., Singer, M. N., Sahni, L. C., Figueroa-Downing, D., McDaniel, D., … Gerber, S. I. (2020). Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016. Pediatrics, 146(1), e20193611. https://doi.org/10.1542/peds.2019-3611 Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample. The Journal of infectious diseases, 226(Suppl 2), S154–S163. https://doi.org/10.1093/infdis/jiac120

BRASH es un acrónimo relativamente nuevo que describe un síndrome de bradicardias con hipotensión severa en el contexto de fallo renal e hiperkalemia. Usted está atendiendo a un masculino de 62 años de edad con debilidad general y desorientación progresivamente peor desde hace varias horas. Mantiene su propia vía aérea y respira espontáneamente, pero no tiene pulsos periféricos palpables. Los signos vitales son 28, 20, 86%, 82/38. Usted coloca al paciente en el monitor cardiaco y observa un bloqueo AV de 3er grado sin ondas P y con un complejo de escape ventricular. De inmediato le coloca oxígeno al paciente mediante mascarilla de no-reinhalación, obtiene dos accesos vasculares, administra 1 mg de atropina y se prepara para realizar intervenciones de segunda línea para aumentar la frecuencia cardiaca, entre ellas, la administración de una infusión de adrenalina y la colocación de un marcapasos externo. Los algoritmos están hechos para evitar desastres. No necesariamente representan el mejor cuidado posible. En este caso, el algoritmo de bradicardia nos dice qué acciones debemos hacer de inicio para mantener al paciente vivo. Sin embargo, no está funcionando. ¿Por qué? Debido a la hiperkalemia. Los medicamentos que causan bloqueo de la conducción a través del nodo atrioventricular (AV) pueden provocar episodios de hipotensión severa y refractaria en el contexto de fallo renal agudo. Bloqueo AV + fallo renal agudo El fallo renal puede ocurrir por cualquier causa no relacionada. El fallo renal pre-renal puede ocurrir, por ejemplo, por deshidratación severa o cualquier otra causa de pobre perfusión sistémica. El fallo renal produce hiperkalemia. La hiperkalemia y el bloqueo del nodo AV por los bloqueadores beta y/o por los bloqueadores de canales de calcio produce la hipotensión. BRASH: un acrónimo a recordar cuando se trata bradicardias sintomáticas Bradicardia Fallo Renal Bloqueo AV Shock Hiperkalemia Cada una de estas condiciones presenta un problema por sí mismo. Cuando se combinan, tienen un efecto sinergístico. Es decir, tiene un efecto más potente que la suma de sus partes individuales. BRASH no es un diagnóstico por separado, sino una descripción de los signos y síntomas asociados al ciclo vicioso de bradicardia, shock, fallo renal e hiperkalemia. Ciclo vicioso de bradicadia, shock, fallo renal e hiperkalemia La bradicardia puede venir por los medicamentos y/o por la hiperkalemia. En el paciente que ya toma estos medicamentos de forma continua, es posible que un deterioro súbito en la función renal de paso a la hiperkalemia. La causa del deterioro súbito de la función renal puede ser por cualquier causa pre-renal, renal o pos-renal. Una causa común de fallo renal pre-renal es cualquier causa de shock que provoque un episodio sostenido de pobre perfusión renal. El resultado es un aumento en los niveles de potasio debido a la pobre eliminación renal. La hiperkalemia produce bloqueo AV y bradicardia, lo que puede agravar aún más la bradicardia y agravar aún más la pobre perfusión renal, lo que provoca a su vez una peor hiperkalemia. SAMPLE El historial clínico del paciente es fundamental para entender el problema. Signos y síntomas Alergias Medicamentos Padecimientos Última ingesta ("last meal") Evento que precedió la emergencia Pistas importantes del historial El historial puede dar a relucir el hecho de que el paciente esté tomando medicamentos que bloquean el nodo AV. Quizás un cambio reciente en la dosis, o la introducción de otro medicamento que tenga un efecto en los niveles de potasio puede ser el detonante reciente. El historial puede dar a relucir el hecho de que el paciente ya padezca de una condición renal previa. El historial puede dar a relucir algún evento reciente que haya provocado el deterioro agudo en la función renal. Trate la bradicardia, la hiperkalemia y la causa de la pobre perfusión El manejo de la bradicardia puede no ser suficiente para lograr estabilizar hemodinámicamente al paciente con BRASH. Es importante reconocer rápidamente y tratar de inmediato de la hiperkalemia. Aunque las ondas T picudas e hiperagudas son signos clásicos de la hiperkalemia, son signos demasiado tempranos. La evolución natural de la condición va a producir bloqueo AV y prolongamiento del complejo QRS. Es decir, es la propia bradicardia y bloqueo AV el mejor signo de que el paciente puede tener una hiperkalemia. Simultáneo al manejo de la bradicardia y de la hiperkalemia, es esencial tratar la causa que está provocando la pobre perfusión renal (por ejemplo, fallo pre-renal por pobre perfusión). Si esto no se corrige, el escenario va a volver a repetirse. Pequeños estímulos con grandes efectos Como mencionado anteriormente, el efecto de esta combinación es sinergístico. Es decir, el efecto combinado es más grande que la suma de sus efectos individuales. No tiene que haber ocurrido un cambio en la dosis que el paciente está tomando del medicamento que bloquea el nodo AV, ni tiene que ser una dosis especialmente alta. Puede ser la misma dosis que ha tomado por largo tiempo sin efectos adversos. Un episodio reciente de deshidratación no tiene que llevar a fallo renal pre-renal. Sin embargo, en presencia del efecto del medicamento que bloquea el nodo AV, tiene un efecto dramático en el riñón. La hiperkalemia no tiene que ser de inicio muy alta. Es decir, no hay una correlación entre niveles específicos de potasio en sangre y los efectos observados. Peor aún, los cambios en el EKG no necesariamente van a progresar de la misma manera que siempre se habla de la hiperkalemia (primero ondas T hiperagudas). Como mencioné anteriormente, la bradicardia quizás es el único indicio. Entonces, cada uno de los estímulos no tiene que ser muy significativo: una dosis normal del medicamento que siempre ha tomado, un episodio relativamente benigno de deshidratación (por ejemplo), un nivel de potasio levemente elevado... pero la combinación produce una bradicardia severa, con fallo renal, bloqueo AV, shock e hiperkalemia... mejor conocido como BRASH. Referencias Arif AW, Khan MS, Masri A, Mba B, Talha Ayub M, Doukky R. BRASH Syndrome with Hyperkalemia: An Under-Recognized Clinical Condition. Methodist Debakey Cardiovasc J. 2020 Jul-Sep;16(3):241-244. doi: 10.14797/mdcj-16-3-241. PMID: 33133361; PMCID: PMC7587309. Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. 2020 Aug;59(2):216-223. doi: 10.1016/j.jemermed.2020.05.001. Epub 2020 Jun 18. PMID: 32565167. Lizyness K, Dewald O. BRASH Syndrome. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570643/ https://emcrit.org/ibcc/brash/ https://litfl.com/brash-syndrome/

As the topic of mental health has gained attention over the past several years, you've no doubt heard a couple of related phrases you're not familiar with. One is the vagus nerve. The other is heart rate variability. Here, we'll delve into the vagus nerve and what it's all about. What is the Vagus Nerve? The vagus nerve, also known as the 10th cranial nerve or cranial nerve X, is the longest and most complex of the cranial nerves. It is also known as the "wanderer nerve" due to its long, winding course through the body, connecting various organs and systems. It is a key part of the parasympathetic nervous system, which controls involuntary body functions such as digestion, heart rate, and immune response.“Vagus Nerve: What It Is, Function, Location & Conditions.” Cleveland Clinic, https://my.clevelandclinic.org/health/body/22279-vagus-nerve. Accessed 6 Feb. 2024. The vagus nerve originates in the medulla oblongata, a part of the brain that connects to the spinal cord, and extends down through the neck to the vital abdominal organs.Segal, Dayva. “Vagus Nerve: What to Know.” WebMD, https://www.webmd.com/brain/vagus-nerve-what-to-know. Accessed 6 Feb. 2024. It contains both motor and sensory fibers, which means it can send and receive information.Kenny BJ, Bordoni B. Neuroanatomy, Cranial Nerve 10 (Vagus Nerve) [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537171/ The vagus nerve carries signals between the brain, heart, and digestive system. It is responsible for various bodily functions, including digestion, heart rate, and breathing. It also plays a role in controlling mood, immune response, and the regulation of food intake, satiety, and energy homeostasis.Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018 Mar 13;9:44. doi: 10.3389/fpsyt.2018.00044. PMID: 29593576; PMCID: PMC5859128. Vagus nerve stimulation (VNS) is a treatment method that uses electrical impulses to stimulate the nerve. It's used to treat some cases of epilepsy and depression that don't respond to other treatments. Damage to it can lead to conditions like gastroparesis, where food does not move into the intestines, and vasovagal syncope, a condition where people faint from low blood pressure. Vagal Tone Vagal tone is often used to assess heart function, emotional regulation, and other processes that alter or are altered by changes in parasympathetic activity. A higher resting vagal tone means you have a reserve capacity for stress. You're more stress resilient.Laborde S, Mosley E, Thayer JF. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol. 2017 Feb 20;8:213. doi: 10.3389/fpsyg.2017.00213. PMID: 28265249; PMCID: PMC5316555. Vagal tone is typically measured indirectly by heart rate variability (HRV), which is the variation in time between each heartbeat. HRV is considered a marker of the body's resilience and adaptability to stress, with higher HRV (indicating greater variability in the intervals between heartbeats) generally associated with better health and fitness, greater resilience to stress, and lower risk of disease. The Vagus Nerve and the Gut-Brain Axis The vagus nerve plays a pivotal role in the gut-brain axis, a complex communication network that links the central nervous system (CNS) with the gastrointestinal (GI) tract. This bidirectional pathway allows for the exchange of signals between the gut and the brain, influencing a wide range of bodily functions, including mood, immune response, digestion, and heart rate. Here's how the vagus nerve affects the gut-brain axis: Direct and Indirect Sensing The vagus nerve can directly or indirectly sense a variety of signals from t...

Contributor: Meghan Hurley MD Educational Pearls: Pearls about labor: Labor is split into 3 stages. Stage 1 starts when the first persistent contractions are felt and goes up until the cervix is fully dilated and the mother starts pushing. Stage 1 is split into two phases: the latent phase (cervix is dilated from 0-4 cm), and the active phase (cervix dilates from 4-10 cm). The latent phase can take between 6 and 12 hours with contractions happening every 5 to 15 minutes. The active phase usually lasts 4-8 hours with contractions occurring as close as every 3 minutes. Stage 2 is the birth itself, lasting between 20 minutes and 2 hours. Stage 3 is the delivery of the placenta and typically takes 30 minutes.  37 weeks gestational age is the cutoff for preterm. Placenta previa: Condition when the placenta overlies the cervix. Classically presents as painless vaginal bleeding in the 3rd trimester. If suspected placenta previa, avoid a speculum exam. Placenta previa can be confirmed on ultrasound.  If the baby is crowning in the ER then the baby should be delivered in the ER. The ideal presentation on crowning is head first (Vertex), specifically ‘left occiput anterior'. In this position, the baby is head first and the head is facing towards the gurney at a slight angle. If the baby is coming out in a breech position then the provider should “elevate the presenting part” by maintaining pressure on the baby as the mother is wheeled to the OR for an emergency C-section. If a vertex-presenting baby is being delivered vaginally, after the head has been delivered an event called ‘restitution' must occur to align the baby's shoulders properly. During this event, the baby goes from facing down towards the gurney to facing sideways. After restitution, the anterior shoulder should be delivered, followed by the posterior. After complete delivery, the cord should be clamped (after a 1-3 minute delay), with something sterile. Gentle downward traction on the cord helps to deliver the placenta. You can place pressure above the pubic bone to prevent the uterus from involuting during this process. This is not the same as a fundal massage which happens after the delivery of the placenta to help the uterus clamp down and prevent postpartum hemorrhage. References Hutchison J, Mahdy H, Hutchison J. Stages of Labor. 2023 Jan 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31335010. Lavery JP. Placenta previa. Clin Obstet Gynecol. 1990 Sep;33(3):414-21. doi: 10.1097/00003081-199009000-00005. PMID: 2225572. Qian Y, Ying X, Wang P, Lu Z, Hua Y. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Arch Gynecol Obstet. 2019 Sep;300(3):531-543. doi: 10.1007/s00404-019-05215-8. Epub 2019 Jun 15. PMID: 31203386; PMCID: PMC6694086. Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

Бие Хүний Завсрын эмгэг нь бидний сэтгэл хөдлөл болон нөхцөл байдалд тохиромжтой хариу үйлдэл үзүүлэхэд доголдол үүсгэдэг эмгэг юм. Бие Хүний Завсрын эмгэг нь Borderline Personality Disorder хэмээн англи хэлнээ хөрвүүлэгддэг бөгөөд энэхүү сэтгэцийн эмгэгтэй хүмүүст сэтгэлзүйн хэт тогтворгүй байдал, огцом сэтгэл хөдлөлөө буруугаар илэрхийлэх мөн өөрийн дотоод мөн чанараа тодорхойлох чадварт нөлөөлдөг байна. Энэхүү эмгэг үүсэхэд олон хүчин зүйлс нөлөөлдөг бөгөөд бага насандаа сэтгэлзүйн болон бие махбодын хүчирхийлэлд өртөж байсан хүмүүс энэхүү эмгэгт өртөх боломж илүү байдаг байна. Нийгмийн амьдралд Бие Хүний Завсрын эмгэгтэй хүмүүс оролцоход хүндрэлтэй байдаг бөгөөд энэ нь тэдний хурц зан үйл мөн сэтгэл хөдлөлтэй холбоотой байна. Мөн нийгмийн сэтгэлзүйн эрүүл мэндийн мэдлэг дутмагаас болж олон хүмүүс эдгээр хүмүүсийг буруугаар ойлгож үүнээс болоод сэтгэцийн эмгэгтэй хүмүүс нийгэмд буруугаар ойлгогдох суур нь тавигддаг байна. Volunteer-оор орох сонирхолтой хүмүүс доорх линкээр орж application бөглөөрэй. Link: https://forms.gle/8tn8Dmx2bHNQFFrGA Бичвэрийн болон подкастын эх сурвалж: 1. Chapman J, Jamil RT, Fleisher C. Borderline Personality Disorder. [Updated 2023 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430883/ 2. Stone, M. H. (2000). Violence in adolescents : Background factors ; implications for treatment. Personality and Conduct Disorders, 175–192. https://doi.org/10.3917/greu.isap.2000.01.0175 3. Kristalyn Salters-Pedneault, P. (2020, March 31). What are the genetic causes of borderline personality disorder?. Verywell Mind. https://www.verywellmind.com/genetic-causes-of-borderline-personality-disorder-425157 4. Sun, C., Zhang, W., & Zhou, X. (2023). Causes and treatment of borderline personality disorder in light of genetic and environmental influences. Lecture Notes in Education Psychology and Public Media, 7(1), 492–500. https://doi.org/10.54254/2753-7048/7/2022905 5. Fonagy, P., & Luyten, P. (2016). A multilevel perspective on the development of borderline personality disorder. Developmental Psychopathology, 1–67. https://doi.org/10.1002/9781119125556.devpsy317 6. Schimelpfening, N. (2023, November 2). How dialectical behavior therapy (DBT) works. Verywell Mind. https://www.verywellmind.com/dialectical-behavior-therapy-1067402 7. Linehan, M. M. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48(12), 1060. https://doi.org/10.1001/archpsyc.1991.01810360024003 8. U.S. Department of Health and Human Services. (n.d.). Borderline personality disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/borderline-personality-disorder

Hormone optimization is essential for maintaining a healthy weight, and one of the most important hormones for fat loss is leptin. Leptin helps our bodies maintain a healthy weight by communicating with the brain when fat mass is accumulating, so that the brain can respond by reducing hunger and increasing energy expenditure. Unfortunately, leptin-resistance can develop, causing our brain to stop responding to leptin appropriately, causing the body to gain more and more fat. In this episode, we will discuss the role of leptin and other hormones in the accumulation and loss of fat, and how to optimize these hormones naturally, without the use of harmful weight loss drugs. Citations Dornbush S, Aeddula NR. Physiology, Leptin. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537038/ https://www.novomedlink.com/diabetes/products/treatments/ozempic/about/mechanism-of-action.html Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. [Updated 2023 Jan 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551568/ Müller TD, Finan B, Bloom SR, et al. Glucagon-like peptide 1 (GLP-1). Mol Metab. 2019;30:72-130. doi:10.1016/j.molmet.2019.09.010 Hira T, Trakooncharoenvit A, Taguchi H, Hara H. Improvement of Glucose Tolerance by Food Factors Having Glucagon-Like Peptide-1 Releasing Activity. Int J Mol Sci. 2021;22(12):6623. Published 2021 Jun 21. doi:10.3390/ijms22126623 6. Anand David AV, Arulmoli R, Parasuraman S. Overviews of Biological Importance of Quercetin: A Bioactive Flavonoid. Pharmacogn Rev. 2016;10(20):84-89. doi:10.4103/0973-7847.194044 --- Support this podcast: https://podcasters.spotify.com/pod/show/elanie-welch/support

Welcome to the first episode of Powerful Possibilities.I'm Katherine.I'm an ADHD coach, and I was diagnosed with ADHD and autism in my early 40s. Today I'm discussing life after being diagnosed with ADHD, particularly as an adult. For some of us, this can be an emotional journey. But there are powerful possibilities...Here are the highlights: (5:08) Emotions and coping strategies(12:00) An ADHD diagnosis for adults(15:40) ADHD diagnosis and identity (22:24) Managing an ADHD diagnosis and emotionsMore information:Elizabeth Kubler Ross - stages of grief:https://www.psycom.net/stages-of-griefTyrrell P, Harberger S, Schoo C, et al. Kubler-Ross Stages of Dying and Subsequent Models of Grief. [Updated 2023 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507885/Dr Kristin Neff - Self-Compassion:https://self-compassion.org/Dr Russell Barkley - Emotional self-regulation:https://www.adhdawarenessmonth.org/wp-content/uploads/Barkley-emotional-regulation-v2.pdfSelf-assessment forms:Download (self-assessment link)Download (self-assessment for women link)Link to blog about ADHD and depression:https://lightbulbadhd.com/blog/depression-and-adhdConnect with Katherine here:WebsiteInstagramTiktokFacebookYoutubeLinkedINThreads

Contributor: Meghan Hurley MD Educational Pearls: What is Cellulitis? A common and potentially serious bacterial skin infection. Caused by various types of bacteria, with Streptococcus and Staphylococcus species being the most common. What is Preseptal Cellulitis and why is it more serious than facial cellulitis? Preseptal Cellulitis, also known as Periorbital Cellulitis, is a bacterial infection of the soft tissues in the eyelid and the surrounding area. This requires prompt and aggressive treatment to avoid progression into Orbital Cellulitis. How is Preseptal Cellulitis treated? Oral antibiotics for five to seven days. In the setting of trauma (scratching bug bites) Clindamycin or TMP-SMX (for MRSA coverage) and Amoxicillin-clavulanic acid or Cefpodoxime or Cefdinir. If there is no trauma, monotherapy with amoxicillin-clavulanic acid is appropriate. Check immunization status against H.influenzae and adjust appropriately. What is Orbital Cellulitis, how is it diagnosed, and why is it more serious than Preseptal Cellulitis? Orbital cellulitis involves the tissues behind the eyeball and within the eye socket itself. Key features include: Eye pain. Proptosis (Bulging of the eye out of its normal position). Impaired eye movement. Blurred or double vision. This can lead to three very serious complications: Orbital Compartment Syndrome. This can push eye forward, stretch optic nerve, and threaten vision. Meningitis given that the meninges of the brain are continuous with optic nerve. Endophthalmitis, which is inflammation of the inner coats of the eye. This can also threaten vision. If suspected, get a CT of the orbits and/or an MRI to look for an abscess behind the eyes. How is Orbital Cellulitis treated? IV antibiotics. Cover for meningitis with Ceftriaxone and Vancomycin. Add Metronidazole until intracranial involvement has been ruled out. Drain the abscess surgically. Usually this is performed by an ophthalmologist or an otolaryngologist. Admit to the hospital. References Bae C, Bourget D. Periorbital Cellulitis. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261970. Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Al-Anezi F, Arat YO, Holck DE. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East. Ophthalmology. 2007 Feb;114(2):345-54. doi: 10.1016/j.ophtha.2006.07.059. PMID: 17270683. Seltz LB, Smith J, Durairaj VD, Enzenauer R, Todd J. Microbiology and antibiotic management of orbital cellulitis. Pediatrics. 2011 Mar;127(3):e566-72. doi: 10.1542/peds.2010-2117. Epub 2011 Feb 14. PMID: 21321025. Wong SJ, Levi J. Management of pediatric orbital cellulitis: A systematic review. Int J Pediatr Otorhinolaryngol. 2018 Jul;110:123-129. doi: 10.1016/j.ijporl.2018.05.006. Epub 2018 May 8. PMID: 29859573. Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

October is Breast Cancer Awareness Month and Domestic Violence Awareness Month. In today's episode, learn about the prevalence of domestic violence, the links between systemic racism and domestic violence, the psychology of victims and survivors, and how to support those affected by domestic violence. Resources: Huecker MR, King KC, Jordan GA, et al. Domestic Violence. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499891/ https://www.pnas.org/doi/10.1073/pnas.1821204116 https://m4bl.org/policy-platforms/end-the-war-black-women/ https://sanctuaryforfamilies.org/our-approach/advocacy/justice-for-incarcerated-survivors-ny/ https://www.loveisrespect.org/resources/how-to-make-a-go-bag-when-leaving-an-abusive-relationship/ If you or someone you know is currently a victim of domestic violence, help and support are available. Please call your local domestic violence response organization, or call the National Domestic Violence Hotline at 1-800-799-7233. The call is free and confidential and someone is available to support you 24/7, 365 days a year. Book The Black Woman's Guide to Overcoming Domestic Violence: Tools to Move Beyond Trauma, Reclaim, Freedom & Create the Life You Deserve By: Shavonne J. Moore-Lobban PhD & Robyn L. Gobin PhD Connect with Dr. Cherie: https://www.instagram.com/drcherie_holisticcoach/  www.instagram.com/passionatestewardshippodcast https://lcconsultingandcoaching.com/  Sign-Up for the Passionate Stewardship Box: https://the-passionate-stewardship-box-64f1fee85eaca.subbly.me/

Contributor: Travis Barlock MD Education Pearls: The Cushing Reflex is a physiologic response to elevated intracranial pressure (ICP) Cushing's Triad: widened pulse pressure (systolic hypertension), bradycardia, and irregular respirations Increased ICP results from systolic hypertension, which causes a parasympathetic reflex to drop heart rate, leading to Cushing's Triad.  The Cushing Reflex is a sign of herniation Treatment includes: Hypertonic saline is comparable to mannitol and preferable in patients with hypovolemia or hyponatremia Give 250-500mL of 3%NaCl 20% Mannitol - given at a dose of 0.5-1 g/kg Each additional dose of 0.1 g/kg reduces ICP by 1 mm Hg 23.4% hypertonic saline is more often given in the neuro ICU 8.4% Sodium bicarbonate lowers ICP for 6 hours without causing metabolic acidosis Non-pharmacological interventions: Raise the head of the bed to 30-45 degrees Remove the c-collar to improve blood flow to the head Hyperventilation induces hypocapnia, which will vasoconsrict the cerebral arterioles You hyperventilate on the way to the OR. Otherwise, maintain normocapnia. References Alnemari AM, Krafcik BM, Mansour TR, Gaudin D. A Comparison of Pharmacologic Therapeutic Agents Used for the Reduction of Intracranial Pressure After Traumatic Brain Injury. World Neurosurg. 2017;106:509-528. doi:10.1016/j.wneu.2017.07.009 Bourdeaux C, Brown J. Sodium bicarbonate lowers intracranial pressure after traumatic brain injury. Neurocrit Care. 2010;13(1):24-28. doi:10.1007/s12028-010-9368-8 Dinallo S, Waseem M. Cushing Reflex. [Updated 2023 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549801/ Godoy DA, Seifi A, Garza D, Lubillo-Montenegro S, Murillo-Cabezas F. Hyperventilation therapy for control of posttraumatic intracranial hypertension. Front Neurol. 2017;8(JUL):1-13. doi:10.3389/fneur.2017.00250 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII  

Contributor: Meghan Hurley MD Educational Pearls: What is ATLS? Advanced Trauma Life Support (ATLS) is a systematic and comprehensive approach to the evaluation and management of trauma patients It was developed by the American College of Surgeons (ACS) The key components include the Primary Survey ("ABCDE"), the Secondary Survey, Definitive Care, and Special Considerations What are the issues with ATLS? ATLS relies on many algorithms and rules-of-thumb, which might be helpful for individuals with basic skills and training but might actually present obstacles for those with higher levels of training. Dr. Hurley cites several examples. Example 1: ABC approach to trauma patients ABC stands for Airway, Breathing, and Circulation but focusing on the airway first is not always the best decision. Immediate attention may need to be applied to massive hemorrhage. Intubating a patient that is hemodynamically unstable may cause cardiac arrest. A more helpful phrase might be “Resuscitate before you intubate.” Example 2: C-spine precautions Cervical collars may impede the likelihood of first-pass success when intubating. The risk of complications from a failed airway may often outweigh the risk of causing a spinal cord injury. Example 3:Cutting clothes off. The E of ABCDE stands for exposure which means fully undressing the patient to look for missing injuries. This often involves cutting their clothes off. This practice might be too broadly applied and leave low-risk trauma patients without any clothes to wear when discharged home. Example 4: Digital rectal exam A rectal exam can be a useful tool in the evaluation of patients with abdominal or pelvic injuries. It can help screen for rectal bleeding, pelvic fractures, and neurological function However, the rectal exam is not a sensitive test. A retrospective study from the Indian Journal of Surgery found that a rectal exam missed 100% of urethra injuries, 92% of spinal cord injuries, 93% of small bowel injuries, 100% of colon injuries, and 67% of rectal injuries in trauma patients. Example 6: Pushing on pelvis for pelvic injuries Pushing on the pelvis to check for instability can cause further damage to an unstable pelvis. Imaging the pelvis is far more important than pressing on it if a pelvic fracture is suspected.  Example 7: FAST exam A FAST exam, which stands for "Focused Assessment with Sonography for Trauma," is a rapid ultrasound examination used to assess trauma patients for signs of internal bleeding or organ damage in the abdomen and chest. These can be very useful as an initial test to tell a trauma surgeon where to start looking for internal bleeding in an unstable blunt traumatic injury If a patient is stable and likely going to get a CT scan whether the FAST is positive or negative then the test is unnecessary References ATLS Subcommittee; American College of Surgeons' Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013 May;74(5):1363-6. doi: 10.1097/TA.0b013e31828b82f5. PMID: 23609291. Bloom BA, Gibbons RC. Focused Assessment With Sonography for Trauma. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261902. Brown R. Oxygenate and Resuscitate Before You Intubate. Common pitfalls to avoid when managing the crashing airway. EMS World. 2016 Jan;45(1):48-50, 52, 54-5. PMID: 26852546. Chrimes N, Marshall SD. Attempt XYZ: airway management at the opposite end of the alphabet. Anaesthesia. 2018 Dec;73(12):1464-1468. doi: 10.1111/anae.14361. Epub 2018 Jul 11. PMID: 29998563. Docimo S Jr, Diggs L, Crankshaw L, Lee Y, Vinces F. No Evidence Supporting the Routine Use of Digital Rectal Examinations in Trauma Patients. Indian J Surg. 2015 Aug;77(4):265-9. doi: 10.1007/s12262-015-1283-y. Epub 2015 May 19. PMID: 26702232; PMCID: PMC4688269. Groeneveld A, McKenzie ML, Williams D. Logrolling: establishing consistent practice. Orthop Nurs. 2001 Mar-Apr;20(2):45-9. doi: 10.1097/00006416-200103000-00011. PMID: 12024634. Morgenstern, J. The FAST exam: overused and overrated?, First10EM, August 30, 2021. Rodrigues IFDC. To log-roll or not to log-roll - That is the question! A review of the use of the log-roll for patients with pelvic fractures. Int J Orthop Trauma Nurs. 2017 Nov;27:36-40. doi: 10.1016/j.ijotn.2017.05.001. Epub 2017 May 10. PMID: 28797555. Sapsford W. Should the 'C' in 'ABCDE' be altered to reflect the trend towards hypotensive resuscitation? Scand J Surg. 2008;97(1):4-11; discussion 12-3. doi: 10.1177/145749690809700102. PMID: 18450202. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014 Mar 15;31(6):531-40. doi: 10.1089/neu.2013.3094. Epub 2013 Nov 6. PMID: 23962031; PMCID: PMC3949434. Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries.  Hosts: - Dr. Tam Pham: UW Medicine Regional Burn Center - Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center - Dr. Alex Morzycki: UW Medicine Regional Burn Center - Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: - Review the epidemiology and common mechanisms for electrical injuries  - Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems - Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release - Recognize possible long-term complications of electrical injuries and their subsequent management References: 1.     Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297. 2.     Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345. 3.     Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265. 4.     Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/ 5.     Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008 6.     Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47  7.     Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908 8.     Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33 9.     Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94 10.  Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26. 11.  Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries.  Hosts: - Dr. Tam Pham: UW Medicine Regional Burn Center - Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center - Dr. Alex Morzycki: UW Medicine Regional Burn Center - Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: - Review the epidemiology and common mechanisms for electrical injuries  - Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems - Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release - Recognize possible long-term complications of electrical injuries and their subsequent management References: 1.     Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297. 2.     Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345. 3.     Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265. 4.     Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/ 5.     Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008 6.     Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47  7.     Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908 8.     Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33 9.     Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94 10.  Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26. 11.  Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

Contributor: Meghan Hurley MD Educational Pearls: Shift work is defined as anything that takes place outside of a 9-5 schedule, not exempting day-shift medical workers Various ill effects of shift work on overall health: Increased all-cause mortality Increased number of accidents Glucose metabolism dysregulation Increased BMI Fertility impacts for men and women Increased breast cancer risk Decreased cognitive functioning Mitigation strategies Work at the same time every day Anchor Sleep - always try to be asleep at the same time of day Progressive shifts: day- into swing- into night shift instead of the other way around Three days off after a stretch of nights can help reset sleep schedule Shorter night shifts Morning shifts should start no earlier than 8 AM Sleep hygiene Ensure an ideal sleep environment; cool, dark, and damp Avoid bright lights when going to sleep Exposure to bright lights when waking up Hydration throughout your shift Stop caffeine at midnight if you are working a night shift Eat healthy meals and avoid junk food Avoid eating 2-3 hours before going to sleep References Boivin, D. B., Boudreau, P., & Kosmadopoulos, A. (2022). Disturbance of the Circadian System in Shift Work and Its Health Impact. Journal of biological rhythms, 37(1), 3–28. https://doi.org/10.1177/07487304211064218 Jang TW. Work-Fitness Evaluation for Shift Work Disorder. Int J Environ Res Public Health. 2021;18(3):1294. Published 2021 Feb 1. doi:10.3390/ijerph18031294 Minors DS, Waterhouse JM. Anchor sleep as a synchronizer of rhythms on abnormal routines. Int J Chronobiol. 1981;7(3):165-188. Reinganum MI, Thomas J. Shift Work Hazards. [Updated 2023 Jan 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK589670/ Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII  

Did you know that salicylate containing substances alone were responsible for over 6,000 cases of pediatric poison exposures in 2020? Dr. Arden Conway, a Pediatric Critical Care Physician, joins Medical Students Morgan Franklin and Ifrah Waris to discuss the evaluation and management for salicylate overdose in a pediatric patient. Specifically, they will:  • Review the pathophysiology of salicylate toxicity • Review the basic assessment skills for acutely ill pediatric patients • Discuss the diagnostic options and evaluation for a child presenting with a potential salicylate overdose • Discuss the management and monitoring of salicylate overdose • Medications and treatments reviewed: activated charcoal, elimination enhancement, hemodialysis  • Discuss the potential complications of salicylate overdose Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode. FREE CME Credit (requires free sign-up): Link Coming Soon! References:  Anderson, M. (2021). Initial management of suspected poisoning in children and young people. Paediatrics and Child Health, 31(10), 382-387. Chyka PA, Erdman AR, Christianson G, Wax PM, Booze LL, Manoguerra AS, Caravati EM, Nelson LS, Olson KR, Cobaugh DJ, Scharman EJ, Woolf AD, Troutman WG; Americal Association of Poison Control Centers; Healthcare Systems Bureau, Health Resources and Sevices Administration, Department of Health and Human Services. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi: 10.1080/15563650600907140. Darracq, M. A., & Cantrell, F. L. (20136). Hemodialysis and extracorporeal removal after pediatric and adolescent poisoning reported to a state poison center. The Journal of Emergency Medicine., 44(6), 1101–1107. https://doi.org/10.1016/j.jemermed.2012.12.018 Espírito Santo, R., Vaz, S., Jalles, F., Boto, L., & Abecasis, F. (2017). Salicylate Intoxication in an Infant: A Case Report. Drug safety - case reports, 4(1), 23. https://doi.org/10.1007/s40800-017-0065-9 Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, Pham NPT, Weber J. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec;59(12):1282-1501. doi: 10.1080/15563650.2021.1989785. Mukerji V, Alpert MA, Flaker GC, Beach CL, Weber RD. Cardiac conduction abnormalities and atrial arrhythmias associated with salicylate toxicity. Pharmacotherapy. 1986 Jan-Feb;6(1):41-3. doi: 10.1002/j.1875-9114.1986.tb03449.x. Palmer, B. F., & Clegg, D. J. (2020). Salicylate toxicity. New England Journal of Medicine, 382(26), 2544-2555. Runde TJ, Nappe TM. Salicylates Toxicity. [Updated 2021 Jul 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499879/

Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode: Patient Testimonial re: SPRINT PNS (superior gluteal and superior cluneal nerve) Superior Gluteal Nerve Anatomy Hip Innervation Upcoming Private and Group Ultrasound Training Upcoming Pain Management Conferences   Course Calendar 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR Oct. 28 Regional Anesthesia and Interventional Pain Medicine NYC Nov.11 Regenerative Pain Medicine Course: NYC   Dec. 16th Regional Anesthesia and Interventional Pain Ultrasound Training NYC 2024 Jan. 6 Regional Anesthesia and Interventional Pain Ultrasound Training NYC For  up to date Calendar, Click Here! Pain Management Board Review   Subscribe to Receive Free Content, Discounts and Course Updates! * indicates required Email Address * References Pierre Laumonerie and others, Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature, Pain Medicine, Volume 22, Issue 5, May 2021, Pages 1149–1157, https://doi.org/10.1093/pm/pnab061 Pinho, A.R.; Leite, M.J.; Lixa, J.; Silva, M.R.; Vieira, P.; Nery-Monterroso, J.; Bezerra, M.C.; Alves, H.; Madeira, M.D.; Pereira, P.A. Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region. Diagnostics 2023, 13, 2314. https://doi.org/10.3390/diagnostics13142314 Lung K, Lui F. Anatomy, Abdomen and Pelvis: Superior Gluteal Nerve. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535408/

Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode: Patient Testimonial re: SPRINT PNS (superior gluteal and superior cluneal nerve) Superior Gluteal Nerve Anatomy Hip Innervation Upcoming Private and Group Ultrasound Training Upcoming Pain Management Conferences Course Calendar 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR Oct. 28 Regional Anesthesia and Interventional Pain Medicine NYC Nov.11 Regenerative Pain Medicine Course: NYC   Dec. 16th Regional Anesthesia and Interventional Pain Ultrasound Training NYC 2024 Jan. 6 Regional Anesthesia and Interventional Pain Ultrasound Training NYC For  up to date Calendar, Click Here! Board Review References Pierre Laumonerie and others, Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature, Pain Medicine, Volume 22, Issue 5, May 2021, Pages 1149–1157, https://doi.org/10.1093/pm/pnab061 Pinho, A.R.; Leite, M.J.; Lixa, J.; Silva, M.R.; Vieira, P.; Nery-Monterroso, J.; Bezerra, M.C.; Alves, H.; Madeira, M.D.; Pereira, P.A. Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region. Diagnostics 2023, 13, 2314. https://doi.org/10.3390/diagnostics13142314 Lung K, Lui F. Anatomy, Abdomen and Pelvis: Superior Gluteal Nerve. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535408/

Episode 146: RA vs OA    Future Dr. Magurany explains how to differentiate rheumatoid arthritis from osteoarthritis.  Written by Thomas Magurany, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.1. Etiology: Rheumatoid Arthritis (RA): RA is an autoimmune disease wherein the immune system mistakenly attacks healthy tissues, particularly the synovial joints, usually between the ages of 30-50. Genetic predisposition, environmental factors such as smoking or infections, hormonal imbalances, and lower socioeconomic status have been associated with an increased risk of developing RA(1).Osteoarthritis (OA): OA primarily arises due to mechanical stress on the joints over time. Factors contributing to OA include age, obesity, joint injury or trauma, repetitive joint use or overuse, genetic abnormalities in collagen structure, and metabolic disorders affecting cartilage metabolism (2).The greatest risk factor for the development of OA is age with most patients presenting after 45 years of age. The greatest modifiable risk factor for OA is weight. People with a BMI >30 were found to have a 6.8 times greater risk of developing OA. (3) Primary OA is the most common and is diagnosed in the presence of associated risk factors such as: older age, female gender, obesity, anatomical factors, muscle weakness, and joint injury (occupation/sports activities) in the absence of trauma or disease. Secondary OA occurs alongside a pre-existing joint deformity including trauma or injury, congenital joint disorders, inflammatory arthritis, avascular necrosis, infectious arthritis, Paget disease, osteopetrosis, osteochondritis dissecans, metabolic disorders (hemochromatosis, Wilson's disease), Ehlers-Danlos syndrome, or Marfan syndrome.2. Pathogenesis:Rheumatoid Arthritis (RA):In some patients, RA is triggered by some sort of environmental factor in a genetically predisposed person. The best example is tobacco use in a patient with HLA-DRB1. The immune response in RA starts at sites distant from the synovial joints, such as the lung, gums, and GI tract. In these tissues, modified proteins are produced by biochemical reactions such as citrullination. (4)In RA, an abnormal immune response leads to chronic inflammation within the synovium lining the joints. The inflammatory cytokines released cause synovitis and lead to the destruction of articular cartilage and bone erosion through pannus formation. Immune cells infiltrate the synovium causing further damage. (4) In summary: formation of antibodies to citrullinated proteins, these antibodies begin attacking wrong tissues.Osteoarthritis (OA):The primary pathological feature of OA is the degeneration of articular cartilage that cushions the joints causing surface irregularity, and focal erosions. These changes progress down the bone and eventually involve the entire joint surface. Mechanical stress triggers chondrocyte dysfunction, leading to an imbalance between cartilage synthesis and degradation that cause cartilage outgrowths that ossify and form osteophytes. This results in the release of enzymes that degrade the extracellular matrix, leading to progressive cartilage loss. As more of the collagen matrix is damaged, chondrocytes undergo apoptosis. Improperly mineralized collagen causes subchondral bone thickening; in advanced disease, bone cysts infrequently occur (5). In summary: Osteophytes formation and cartilage loss.3. Clinical Presentation:Rheumatoid Arthritis (RA):The most common and predominant symptoms include joint pain and swelling, usually starting insidiously over a period of weeks to months. RA typically affects multiple joints symmetrically, commonly involving small joints of the hands, wrists, feet and progresses to involve proximal joints if left untreated. Morning stiffness lasting more than an hour is a characteristic feature. The affected joint will be painful if pressure is applied to the joint or on movement with or without joint swelling. Synovial thickening with a "boggy" feel on palpation will be noted. The classical physical findings of ulnar deviation, metacarpophalangeal joint subluxation, swan neck deformity, Boutonniere deformity, and the "bowstring" sign (prominent and tight tendons on the dorsum of the hand) are seen in advanced chronic disease. (4) Around ¼ of patients with RA may present with rheumatoid noduleswhich are well demarcated, flesh-colored subcutaneous lumps. They are usually described as being doughy or firm and are not typically tender unless they are inflamed. They are usually found on areas susceptible to repeated trauma or pressure and include the elbows, fingers and forearms. Osteoarthritis (OA):OA primarily affects weight-bearing joints such as knees, hips, spine, and hands. Symptoms include joint pain aggravated by activity and relieved with rest, morning stiffness lasting less than 30 minutes, joint swelling due to secondary inflammation, and occasionally the formation of bony outgrowths called osteophytes (6). Tenderness may be present at joint lines, and there may be pain upon passive motion. Classic physical exam findings in hand OA include Heberden's nodes (posterolateral swellings of DIP joints), Bouchard's nodes (posterolateral swellings of PIP joints), and “squaring” at the base of the thumb (first Carpal-Metarcapal or CMC joints), bony enlargement, crepitus, effusions (non-inflammatory), and a limited range of motion. Patients may also experience bony swelling, joint deformity, and instability (patients complain that the joint is “giving way” or “buckling,” a sign of muscle weakness). (5)4. Lab findings:Rheumatoid Arthritis: Laboratory testing often reveals anemia of chronic disease (increased ferritin, decreased iron and TIBC) and thrombocytosis. Neutropenia may be present if Felty syndrome is present. RF is present in 80-90% of patients with a sensitivity of 69%. In patients who are asymptomatic or those that have arthralgias, a positive RF and especially CCP predicts the onset of clinical RA. Patients with RA with RF, ACPA, or both are designated as having seropositive RA. About 10% of RA patients are seronegative. ESR and levels of CRP are usually elevated in patients with active disease and can be used to assess disease activity. The synovial fluid in RA will also reveal low C3 and C4 levels despite elevated serum levels.(4) Some non-specific inflammatory markers such as ESR, CRP can help you guide your diagnosis of RA.Osteoarthritis:Lab findings are not significant. Clinical diagnosis if the following are present: 1) pain worse with activity and better with rest, 2) age more than 45 years, 3) morning stiffness lasting less than 30 minutes, 4) bony joint enlargement, and 5) limitation in range of motion. Blood tests such as CBC, ESR, rheumatoid factor, ANA are usually normal but usually ordered to rule out an inflammatory process. Synovial fluid should show a white blood cell count less than 2,000/microL, predominantly mononuclear cells (non-inflammatory). X-rays of the affected joint can show findings consistent with OA, such as marginal osteophytes, joint space narrowing, subchondral sclerosis, and cysts; however, radiographic findings do not correlate to the severity of the disease and may not be present early in the disease. (5)5. Treatment Approaches:Rheumatoid Arthritis (RA):There is no cure for RA.The goal of treatment in RA is inducing remission and optimizing quality of life. This is initially done by beginning DMARDs, include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Methotrexate is the initial DMARD of choice. Anti-TNF-alpha inhibitors include etanercept, infliximab, adalimumab, golimumab, and certolizumab may be used if DMARDs fail. NSAIDs are used to control joint pain and inflammation. Corticosteroids may be used as a bridge therapy to DMARDs in a newly diagnosed patient with a very active disease. (7) Coronary artery disease has a strong association with RA. RA is an independent risk factor for the development of coronary artery disease (CAD) and accelerates the development of CAD in these patients. Accelerated atherosclerosis is the primary cause of morbidity and mortality. There is increased insulin resistance and diabetes mellitus associated with RA and is thought to be due to chronic inflammation. When treated with specific DMARDs such as hydroxychloroquine, methotrexate, and TNF antagonists, there was a marked improvement in glucose control in these patients. (8) RA is not just a disease of the joints, it is able to affect multiple organ systems.Osteoarthritis (OA):OA treatment aims at reducing pain and improving joint function through a combination of non-pharmacological interventions like exercise programs tailored to strengthen muscles around affected joints, weight management strategies, and assistive devices like braces or walking aids if required (9). Medications including analgesics or nonsteroidal anti-inflammatory drugs may be prescribed for pain relief when necessary. Duloxetine has modest activity in relieving pain associated with OA. Intraarticular glucocorticoid joint injections have a variable response but are an option for those wanting to postpone surgical intervention. In severe cases where conservative measures fail, surgical options like joint replacement may be considered (9). Weight loss is a critical intervention in those who have overweight and obesity; each pound of weight loss can decrease the load across the knee 3 to 6-fold. (5) Summary: Medications (NSAIDs, topical, duloxetine), weight loss, PT, intraarticular injections of corticosteroids, and joint replacement.________________________________Conclusion: Now we conclude episode number 146, “RA vs. OA.” Future Dr. Magurany explained that rheumatoid arthritis is an autoimmune disease that presents with joint pain and inflammation, mostly on hands and small joints, accompanied by morning stiffness longer than 1 hour. The rheumatoid factor and ACPA may be positive in a percentage of patients but not always. The base of treatment is early treatment with disease-modifying antirheumatic drugs to induce remission of the disease. OA affects weight-bearing joints with little to no inflammation, treatment is mainly lifestyle modifications, analgesics, intraarticular injections, and joint replacement.This week we thank Hector Arreaza and Thomas Magurany. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Myasoedova E, Crowson CS & Gabriel SE et al. (2010). Is the incidence of rheumatoid arthritis rising?: Results from Olmsted County, Minnesota, 1955-2007. Arthritis and Rheumatism, 62(6), 1576-1582.Goldring MB & Goldring SR. (2007). Osteoarthritis. Journal of Cellular Physiology, 213(3), 626-634.King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res. 2013;138(2):185-93. PMID: 24056594; PMCID: PMC3788203.Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Hunter DJ, Bierma-Zeinstra S. & Eckstein F. (2014). OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary hip and knee osteoarthritis: An expert consensus initiative of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) Task Force in collaboration with the Osteoarthritis Research Society International (OARSI). Osteoarthritis Cartilage, 22(7), 363-381.van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, Bijlsma JW. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med. 2002 Jan 1;136(1):1-12. doi: 10.7326/0003-4819-136-1-200201010-00006. PMID: 11777359.Nicolau J, Lequerré T, Bacquet H, Vittecoq O. Rheumatoid arthritis, insulin resistance, and diabetes. Joint Bone Spine. 2017 Jul;84(4):411-416.Fernandes L, Hagen KB, Bijlsma JWJ et al. (2019). EULAR recommendations for non-pharmacological core management of hip and knee osteoarthritis. Annals of Rheumatic Diseases, 79(6), 715-722.Royalty-free music used for this episode: "Driving the Point." Downloaded on July 29, 2023, from https://www.videvo.net/ 

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy's Continuing Medical Education Programs, discusses: Genicular Nerve Ablation with Phenol The history of phenol The mechanism of action Indications Complications Clinical concerns when considering neurolysis with phenol   Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/9GkVWu Ultrasound Workshops and Courss Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR For  up to date Calendar, Click Here! References D'Souza RS, Warner NS. Phenol Nerve Block. [Updated 2023 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.     Risso CR e tal.Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective StudyVolume21, Issue4. April 2021Pages 438-444

Description: An immersive reading of excerpts from Treasure Island by Robert Louis Stevenson with reflection on alcohol withdrawal, bargaining and grey. Website:https://anauscultation.wordpress.com/ Work:excerpts from Treasure Island by Robert Louis Stevenson But he broke in cursing the doctor, in a feeble voice but heartily. “Doctors is all swabs,” he said; “and that doctor there, why, what do he know about seafaring men? I been in places hot as pitch, and mates dropping round with Yellow Jack, and the blessed land a- heaving like the sea with earthquakes — what to the doctor know of lands like that?— and I lived on rum, I tell you. It's been meat and drink, and man and wife, to me; and if I'm not to have my rum now I'm a poor old hulk on a lee shore, my blood'll be on you, Jim, and that doctor swab”; and he ran on again for a while with curses. “Look, Jim, how my fingers fidges,” he continued in the pleading tone. “I can't keep 'em still, not I. I haven't had a drop this blessed day. That doctor's a fool, I tell you. If I don't have a drain o' rum, Jim, I'll have the horrors; I seen some on 'em already. I seen old Flint in the corner there, behind you; as plain as print, I seen him; and if I get the horrors, I'm a man that has lived rough, and I'll raise Cain. Your doctor hisself said one glass wouldn't hurt me. I'll give you a golden guinea for a noggin, Jim.”References:Treasure Island paperback: https://www.tatteredcover.com/book/9780008514587 Treasure Island digital: https://www.gutenberg.org/files/120/120-h/120-h.htm Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Rosenbaum M, McCarty T. Alcohol prescription by surgeons in the prevention and treatment of delirium tremens: historic and current practice. Gen Hosp Psychiatry. 2002;24(4):257-259.Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014;371(22):2109-2113.NB: Tattered Cover is a local Denver bookstore 

Episode 133: Neonatal JaundiceJennifer explained the pathophysiology of neonatal jaundice and how to treat it and described why screening for hyperbilirubinemia is important.    Written by Jennifer Lai, MS3, College of Osteopathic Medicine of the Pacific Western University of Health Sciences. Comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is neonatal jaundice? Jenni: Infant jaundice, also known as hyperbilirubinemia, is when there is a high level of serum bilirubin causing yellow discoloration of the newborn's skin and eyes. Bilirubin is a red-orange byproduct of hemoglobin catabolism that gives yellow pigment to skin and mucosa membranes. Arreaza: When we see jaundice on the eyes, it is actually the conjunctiva color we are seeing. So, the term “scleral icterus” should be changed to “conjunctival icterus,” but you may get corrected by unaware clinicians. Bilirubin actually binds elastin.What's the pathophysiology/ big picture?Jenni: The key problem is the accumulation of high levels of bilirubin in serum and if left untreated, it can bind to tissues and cause toxicity. There are multiple reasons why there might be too much bilirubin in the serum. Excess bilirubin can be due to a benign normal condition, but it can also be due to a pathologic reason. It is important to differentiate between these two because the management and treatment can differ significantly. Arreaza: Highly bilirubin means that it is being either overproduced or under-eliminated. Physiologic jaundice Most of the time, hyperbilirubinemia is benign and physiologic, with yellowing typically occurring between 2-4 days. Normally, there is a period of transition caused by the turnover of the fetal red blood cells and the immaturity of the newborn's liver to efficiently metabolize bilirubin and increased enterohepatic circulation. The most common reason is that the liver isn't mature enough to get rid of the bilirubin in the bloodstream or because the baby's gut is sterile, so it does not have the bacteria to convert the bilirubin to get it out of the body. In general, newborns have a higher level of total serum or plasma bilirubin levels compared to adults for the following reasons: Newborns have more red blood cells (hematocrit between 50-60), and fetal red blood cells have a shorter life span (85 days vs. 120 days) than those of adults. After birth, there is an increased turnover of fetal red blood cells, so there is more bilirubin.Bilirubin clearance (conjugation and excretion) is decreased in newborns, mainly because of a deficiency of the hepatic enzyme UGT.Increase in the enterohepatic circulation of bilirubin as the amount of unconjugated bilirubin increases due to the limited bacterial conversion of conjugated bilirubin to urobilin.Pathologic JaundicePathologic jaundice includes severe neonatal hyperbilirubinemia, extreme neonatal hyperbilirubinemia, and bilirubin-induced neurologic disorders. We determine the severity of the jaundice using the total serum bilirubin (TSB). It is defined as a TSB >25 (severe) and TSB >30 (extreme). Other concerning signs include a TSB over the 95% percentile, a greater than 5mg/dL/day or 0.2mg/dL/hour, or jaundice that lasts for more than 2-3 weeks. Potential pathologic causes include but are not limited to: Increased bilirubin production from increased hemolysis which is when the red blood cells in the baby are being destroyed faster than normal, this can be due to blood group incompatibilities where the mom's immune system starts to attack the baby's red blood cells (such as Rh incompatibility) or from RBC membrane defects (spherocytosis).Birth Trauma when the head gets bruised after a vacuum or forceps is used to remove the baby from the vaginal canalInfection which prevents the bilirubin from being metabolized and excretedProblems with bilirubin clearance either from enzyme deficiencies such as Crigler-Najjar or Gilbert syndromeObstructed biliary systems causing bile to get stuck in the liverArreaza: Indirect bilirubin is the one elevated in newborns, but if you see direct hyperbilirubinemia, then you have to think of an obstruction.Jenni: Severe hyperbilirubinemia can cause brain damage. The amount of bilirubin and the duration of bilirubin ultimately determine the severity of the brain damage. This is because the bilirubin blocks some mitochondrial enzymes from being able to function properly, also it inhibits DNA synthesis/protein synthesis, and can cause DNA damage. This can ultimately lead to acute bilirubin encephalopathy which is described as 3 different phases: Phase 1 with poor feeding, lethargy, hypotonia, and seizures, Phase 2 with increased tone in extensor muscles causing neck contractions (retrocollis and opisthotonos), and Phase 3 with generalized increased tone. If the bilirubin encephalopathy persists it can also ultimately cause cerebral palsy, sensorineural hearing loss, and gaze abnormalities.  How and when do we treat? No phototherapy:The goal of treating jaundice is to safely decrease the amount of bilirubin in the body. Oftentimes babies with mild hyperbilirubinemia don't get any treatment and we just watch and wait. In premature babies, there is an increased risk for brain toxicity because a lower amount of bilirubin can result in brain toxicity. For these babies, it is important to ensure there is adequate breast milk to both prevent and treat jaundice because it helps the baby get rid of bilirubin through the stool and urine. Arreaza: Indirect sunlight exposure of the baby.Phototherapy:Other babies get phototherapy or more commonly known as light therapy. Phototherapy light treatment is when the baby's skin is exposed to a special blue light which will help break down bilirubin and help with the excretion in stool and urine. The phototherapy should be continuous and placed on as much skin as possible and the treatment should be administered until bilirubin levels drop to a safe level based on the baby's hour-specific thresholds. Arreaza: Home phototherapy is an option (UV blanket) available for rent or purchase.Phototherapy is very safe, however, with any treatment, there are risks and potential side effects. Some of these include skin rashes, loose stools, overheating, and dehydration. Occasionally, babies turn a dark gray-brown color in their skin and urine, but this is temporary and usually resolves on its own. While the baby is receiving phototherapy, it is important to continue breastfeeding to ensure appropriate fluid hydration, but in babies that cannot get enough breast milk, they may need to supplement with formula or even potentially start IV fluids. Benefits of screeningIt is therefore essential for universal bilirubin screening for all newborns prior to discharge to identify newborns who are at risk for developing severe hyperbilirubinemia. Hyperbilirubinemia is extremely common in newborns, with nearly all neonates having a higher total serum bilirubin than adults. The reason we screen is that this reduces the risk of developing severe hyperbilirubinemia and ultimately brain damage. This universal screening also then decreases hospital readmissions for neonatal hyperbilirubinemia. Arreaza: So, we check at 12-24 hours in a typical pediatric unit. We use a bilimeter (transcutaneous) and if we suspect it is not accurate, we do a serum bili. Be aware of the accuracy of bilimeters.How do we screen? We do this prior to newborn discharge through a transcutaneous bilirubin device (TcB) or lab total serum bilirubin (TSB). The bilirubin level is used with the assessment of risk for the development of severe hyperbilirubinemia. Newborn bilirubin screening guidelines include TSB or TcB within 24-48 hours after birth or before discharge. TcB is the noninvasive test, but TSB is the gold standard for assessing neonatal bilirubin. Newborns with visible jaundice in the first 24 hours should be concerned for severe hyperbilirubinemia. These babies should be screened earlier because of the risk of pathologic causes of jaundice. In addition to the bilirubin test, physicians will clinically assess by examining the skin under ambient or daylight to assess whether there is a yellow discoloration of the buccal, gingival, or conjunctival mucosa. Additionally, if a baby presents with scleral icterus, pallor, bruising, hepatosplenomegaly, or cephalohematoma (enclosed hemorrhage), these can be clinical presentations of neonatal jaundice. Follow up:After screening, we recommend that babies be closely monitored if jaundice does occur as it can be well managed with early treatment. A quick way to assess this at home is to press gently on the baby's forehead and if the skin looks yellow where you press, it's probably jaundice. If your baby doesn't have jaundice, then the place where you pressed it should look lighter than normal. _____________________Conclusion: Now we conclude episode number 133, “Neonatal Jaundice.” Jennifer explained the pathophysiology behind the increased levels of bilirubin in babies. She reminded us that it is a physiologic process, but when the level of bilirubin is too high, then we need to start treatment. Treatments include indirect sunlight exposure of the baby, breastfeeding, and in some cases phototherapy, IV fluids, and even antibiotics and exchange transfusion in some cases. Dr. Arreaza reminded us of the importance of screening and monitoring “bili babies” in the clinic. This week we thank Hector Arreaza and Jennifer Lai. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! ___________________Links:Episode 17: Why does bilirubin deposit in the eyes? – The Curious Clinicians, https://curiousclinicians.com/2021/01/20/episode-17-why-does-bilirubin-deposit-in-the-eyes/.Ansong-Assoku B, Shah SD, Adnan M, et al. Neonatal Jaundice. [Updated 2022 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532930/.Mayo Clinic. “Infant Jaundice – Symptoms and Causes.” Mayo Clinic, 2018, www.mayoclinic.org/disease-conditions/infant-jaundice/symptoms-causes/syc-20373865.“Newborn Jaundice.” Nhs.uk, 19 Oct. 2017, www.nhs.uk/conditions/jaundice-newborn/#:~:text=Jaundcie%20in%20newborn%20babies%20is.Preud'Homme D., “Neonatal Jaundice.” American College of Gastroenterology, Dec 2012, https://gi.org/topics/neonatal-jaundice/.Wong R., et al. “Risk factors, Clinical Manifestations, and Neurologic Complications of Neonatal Uncomplicated Hyperbilirubinemia.” Up to Date, Last Updated: Jan 5, 2023, https://www.uptodate.com/contents/risk-factors-clinical-manifestations-and-neurologic-complications-of-neonatal-unconjugated-hyperbilirubinemiaRoyalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/

Did you know that household Tylenol is one of the most common causes of both intentional and unintentional toxicity in the pediatric population? Dr. George Hsu, a Pediatric Emergency Physician, joins Dr. Rebecca Yang and Medical Students Morgan Franklin and Ifrah Waris to discuss the evaluation and management for acetaminophen overdose in a pediatric patient.  Specifically, they will:  Review the basic assessment skills and evaluation for a child presenting with a potential acetaminophen overdose Discuss the diagnostic options and monitoring of acetaminophen overdose Discuss how to use the Rumack-Matthew nomogram in the treatment of acetaminophen overdose Medications and treatments reviewed: N-acetylcysteine, activated charcoal, and gastric lavage Discuss the potential complications of acetaminophen overdose Special thanks to Dr. Rebecca Yang and Dr. Arden Conway for peer reviewing this episode. Special thanks to Dr. Rebecca Yang and Dr. Arden Conway for peer reviewing the discussion today.  FREE CME Credit (requires free sign-up): Link Coming Soon! References:  Agrawal S, Khazaeni B. Acetaminophen Toxicity. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441917/ Heard K. J. (2008). Acetylcysteine for acetaminophen poisoning. The New England journal of medicine, 359(3), 285–292. https://doi.org/10.1056/NEJMct0708278 Hinson JA. Mechanism of acetaminophen-induced liver toxicity. In: Kaplowitz N, DeLeve LD, eds. Drug-Induced Liver Disease. 3rd ed. London, England: Academic Press; 2013:305-330. Hon KL, Hui WF, Leung AKC. Antidotes for childhood toxidromes. Drugs in Context 2021; 10: 2020-11-4. DOI: 10.7573/dic.2020-11-4 Greene SL, Dargan PI, Jones AL. Acute poisoning: understanding 90% of cases in a nutshell. Postgrad Med J. 2005 Apr;81(954):204-16. doi: 10.1136/pgmj.2004.024794. PMID: 15811881; PMCID: PMC1743253. Lee J, Fan NC, Yao TC, Hsia SH, Lee EP, Huang JL, Wu HP. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr Neonatol. 2019 Feb;60(1):59-67. doi: 10.1016/j.pedneo.2018.04.001. Epub 2018 Apr 19. PMID: 29748113. Manov I, Motanis H, Frumin I, Iancu TC. Hepatotoxicity of anti-inflammatory and analgesic drugs: ultrastructural aspects. Acta Pharmacol Sin. 2006 Mar;27(3):259-72. doi: 10.1111/j.1745-7254.2006.00278.x. PMID: 16490160. Myers WC, Otto TA, Harris E, Diaco D, Moreno A. Acetaminophen overdose as a suicidal gesture: a survey of adolescents' knowledge of its potential for toxicity. J Am Acad Child Adolesc Psychiatry. 1992 Jul;31(4):686-90. doi: 10.1097/00004583-199207000-00016. PMID: 1644732. Park, B. K., Dear, J. W., & Antoine, D. J. (2015). Paracetamol (acetaminophen) poisoning. BMJ clinical evidence, 2015, 2101. Riordan M, Rylance G, Berry K. Poisoning in children 2: painkillers. Arch Dis Child. 2002 Nov;87(5):397-9. doi: 10.1136/adc.87.5.397. PMID: 12390909; PMCID: PMC1763068. Silberman J, Galuska MA, Taylor A. Activated Charcoal. [Updated 2022 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482294/ Shekunov, J., Lewis, C. P., Vande Voort, J. L., Bostwick, J. M., & Romanowicz, M. (2021). Clinical Characteristics, Outcomes, Disposition, and Acute Care of Children and Adolescents Treated for Acetaminophen Toxicity. Psychiatric Services, appi-ps. Sheridan DC, Hendrickson RG, Lin AL, Fu R, Horowitz BZ. Adolescent Suicidal Ingestion: National Trends Over a Decade. J Adolesc Health. 2017 Feb;60(2):191-195. doi: 10.1016/j.jadohealth.2016.09.012. Epub 2016 Nov 23. PMID: 27889404. Silberman J, Galuska MA, Taylor A. Activated Charcoal. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482294/ Runde TJ, Nappe TM. Salicylates Toxicity. [Updated 2021 Jul 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499879/ Yarema M, Chopra P, Sivilotti MLA, Johnson D, Nettel-Aguirre A, Bailey B, Victorino C, Gosselin S, Purssell R, Thompson M, Spyker D, Rumack B. Anaphylactoid Reactions to Intravenous N-Acetylcysteine during Treatment for Acetaminophen Poisoning. J Med Toxicol. 2018 Jun;14(2):120-127. doi: 10.1007/s13181-018-0653-9. Epub 2018 Feb 8. Erratum in: J Med Toxicol. 2018 Mar 12;: PMID: 29423816; PMCID: PMC5962465.  

Welcome back Witches! This week's episode will take a look at Nightmares & Sleep Paralysis!  We're going to discuss the science, the the supernatural, and ways to help prevent them from occurring.  So get in losers, and let's gain some knowledge on Nightmares and Sleep Paralysis. We would be forever thankful if you leave our podcast a 5-Star review. If you really loved the show and want more Get in Loser content, check out our Supercast link below, or search the Supercast website for Get in Loser, We're Doing Witchcraft. You can also find us at our Buy Me a Coffee link below.  There you can purchase a membership to our podcast and obtain exclusives like, getting episodes early, shout outs on the show, access to our “Ask me anything” forum, our monthly newsletter, a promo code for merchandise, and more. You can also find us on Facebook, Twitter and Instagram @GetinWitches, on TikTok @weredoingwitchcraft or email us at weredoingwitchcraft@gmail.com. You  can support our show through our Supercast: https://getinloserweredoingwitchcraft.supercast.com/ Buy Me a Coffee: https://www.buymeacoffee.com/getinwitches Music by Karl Casey @ White Bat Audio- The Witch ----more---- References Hershner, Shelley MD & Morse, Anne M. DO (2020). What is Sleep Paralysis? AASM Sleep Education. https://sleepeducation.org/sleep-disorders/sleep-paralysis/ Newsom, Rob (2022). Sleep Demon. Sleep Foundation. https://www.sleepfoundation.org/parasomnias/sleep-demon#:~:text=When%20sleep%20paralysis%20is%20accompanied,%2C%20or%20vestibular%2Dmotor%20hallucinations. Suni, Eric & Singh, Abhinav, Dr. (2022). Nightmares. Sleep Foundation. https://www.sleepfoundation.org/nightmares Davis, Owen. The Nightmare Experience, Sleep Paralysis, and Witchcraft Accusations. (2010). chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://uhra.herts.ac.uk/bitstream/handle/2299/2342/103471.pdf?sequence=1&isAllowed=n Farooq M, Anjum F. Sleep Paralysis. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562322/ Roybel, Beth.  Sleep Paralysis. (2022). WebMD. https://www.webmd.com/sleep-disorders/sleep-paralysis Stanborough, Rebecca Joy. Understanding ‘Old Hag' Syndrome: What it Means When You're Paralyzed in Your Sleep. (2020) Healthline. https://www.healthline.com/health/sleep/old-hag-syndrome

Do you have a loved one who is always the life of the party, everyone's best friend, and a "drama queen"? If so, they may have a touch of histrionic personality disorder! In this episode, we describe what histrionic personality disorder is and how it could be difficult for loved ones. Then, Kibby has a crushing realization about her own history with histrionic personality disorder and loses track of everything after that. Read more about HPD here: ​Pfohl, B. (1991). Histrionic personality disorder: A review of available data and recommendations for DSM-IV. Journal of Personality Disorders, 5(2), 150-166.and here: French, J. H., & Shrestha, S. (2021). Histrionic personality disorder. In StatPearls [Internet]. StatPearls Publishing.For more info, check out: www.alittlehelpforourfriends.comFollow us on Instagram: @ALittleHelpForOurFriends

References: Frank Lodeserto MD, "High Flow Nasal Cannula (HFNC) – Part 1: How It Works", REBEL EM blog, August 20, 2018. Available at: https://rebelem.com/high-flow-nasal-cannula-hfnc-part-1-how-it-works/. Nishimura, Masaji. (2016). High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respiratory Care, 61(4), 529-41. Sharma S, Danckers M, Sanghavi D, et al. High Flow Nasal Cannula. [Updated 2022 Sep 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526071/

References: Burton LV, Beier K. Papillary Muscle Rupture. [Updated 2022 Jul 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499976/ Jung J, Rice J, Bord S. Rethinking the role of epinephrine in cardiac arrest: the PARAMEDIC2 trial. Ann Transl Med. 2018 Dec;6(Suppl 2):S129. doi: 10.21037/atm.2018.12.31. PMID: 30740450; PMCID: PMC6330609. Thiele, Holger. Abbott, J Dawn. (2022). Acute Myocardial Infarction: Mechanical Complications. Up-to-Date.