Podcasts about Lancet

Early trials of a breakthrough stem cell therapy to treat babies with spina bifida while still in the womb is showing remarkable results. The trial results published today in The Lancet medical journal show babies who were treated with cells from the mother's placenta were born with no signs of infection, abnormal tissue growth or tumour formation. Associate Professor Lana McClements from the University of Technology in Sydney is one of those who has been watching closely, and she spoke to Melissa Chan-Green.

Can a single bolus change the fate of a devastating stroke?

In the next installment of our immigration mini series, we're rebroadcasting the episode, “Empowering disabled refugees,” with Mustafa Rfat from Season 6. Since coming into office, the Trump administration has suspended refugee resettlement, strangled the asylum process, set the lowest refugee admissions cap ever, issued travel bans for immigrants coming from dozens of countries, and eliminated vital services for refugees resettling in the United States. All of these actions have disproportionate impacts for refugees with disabilities, who, according to some estimates, constitute nearly a third of the global refugee population. Check out the original episode page for more about Mustafa Rfat and his research. Also be sure to read his latest article in the Lancet, which highlights the health harms that result from lack of communication access for asylum seekers in detention under the current administration's deportation policies, which blatantly disregard disability rights laws.--Let us know what you think with a comment or review!Visit our website⁠ ⁠for⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ transcripts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Subscribe to Qudsiya's Substack, ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Getting Down To It⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Support the team behind the podcast ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠with a donation⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Season 9 is off to an exceptionally strong start with our recent discussion with Dr. Nicholas Freudenberg, Distinguished Professor Emeritus of Public Health at the City University of New York (CUNY) School of Public Health. Dr. Freudenberg is Senior Faculty Fellow and co-founder of the CUNY Urban Food Policy Institute (www.cunyurbanfoodpolicy.org). He is a leading expert in Commercial Determinants of Health, authoring two key books in the field; At What Cost: Modern Capitalism and the Future of Health (Oxford, 2021) and Lethal but Legal: Corporations, Consumption, and Protecting Public Health (Oxford, 2014 and 2016). He was a contributor to the landmark Lancet series on the topic: https://www.thelancet.com/series-do/commercial-determinants-health.Commercial Determinants of Health can be understood as the ways that market actors influence health and disease globally. Commercial Determinants of Health are related to Social Determinants of Health and Political Determinants of Health, which together form a system that influences patterns of human health and disease. The term developed in the early 2000s, emerging from an earlier concept of Corporate Determinants of Health, recognizing that a small number of multinational global corporations dominate the world economy. Dr. Freudenberg explains that changing behavior of businesses and corporations can achieve public health gains at a much greater scale that traditional individual behavioral change approaches, citing successful policies regulating the tobacco industry and smaller gains changing the business opportunities to favor alternatives to the fossil fuel industry. One of the largest commercial determinants of health is the food industry, where there are multiple opportunities for change. Dr. Freudenberg discusses the importance of coordination between activists and public health professionals to counterbalance the influence of corporations on policy. What is the role of bioethicists? Listen and find out! Bibliography:https://www.annualreviews.org/content/journals/10.1146/annurev-publhealth-052220-020447https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00011-9/abstracthttps://global.oup.com/academic/product/at-what-cost-9780190078621?cc=us&lang=en&https://global.oup.com/academic/product/lethal-but-legal-9780199937196?cc=us&lang=en&

Steatotic liver disease labels hinge on alcohol intake, but self-report is often inaccurate. In this episode, Aleksander Krag (Odense University Hospital) discusses a large Danish study using phosphatidylethanol (PEth), a direct blood biomarker of recent drinking, showing substantial underestimation and potential reclassification from MASLD to MetALD/ALD.Click here to read the full article:https://www.thelancet.com/journals/langas/article/PIIS2468-1253(25)00187-6/fulltextMedical imaging and theranostics are revolutionising how we diagnose, treat, and understand disease. To meet this moment, The Lancet group is happy to announce the launch of, The Lancet Medical Imaging and Theranostics. You can visit https://www.thelancet.com/medical-imaging-theranostics to learn more.Continue this conversation on social! Follow us today at... https://bsky.app/profile/lancetgastrohep.bsky.social https://www.linkedin.com/company/langastro/ https://instagram.com/thelancetgroup https://facebook.com/thelancetmedicaljournal https://youtube.com/thelancettv

In this episode Andrea Samadi interviews Thoryn Stevens, CEO and founder of Brain.One, about using AI, wearables, biomarkers and evidence-based micro-habits to create personalized brain-health protocols. Watch our full interview on YouTube here https://www.youtube.com/watch?v=r9UN9kev2CE or listen and follow the show notes here https://andreasamadi.podbean.com/e/can-ai-personalize-your-brain-health-inside-brainones-protocols/  What We Covered on EP 386 with Thoryn Stephens The Problem with Generic Wellness Advice Why most health advice fails to translate into sustained behavior change The gap between research findings and real-world application Why optimization must be systematic, not inspirational From Data to Daily Micro-Habits How Brain.One analyzes peer-reviewed research using AI Turning biometrics (HRV, sleep data, metabolic markers) into actionable protocols Why small, consistent micro-habits compound into long-term neuroplastic change Wearables & What Actually Matters The most misunderstood wearable metrics HRV, sleep architecture, and recovery as early indicators of cognitive health How to avoid becoming obsessive with numbers while still using data intelligently Dementia Prevention & Cognitive Longevity Evidence-based strategies inspired by the Lancet dementia prevention framework Why metabolic health and inflammation play a critical role in brain aging Prevention vs. reversal: when to start optimizing brain health Biological Bottlenecks to Human Potential Stress dysregulation as a performance limiter Sleep architecture and glymphatic clearance Metabolic flexibility and mitochondrial function Why emotional regulation remains foundational to cognitive performance AI in Health: Hype vs. Evidence What makes Brain.One's system evidence-constrained How AI can scale personalized health protocols The future of data-driven behavioral optimization

The ACOG states that, “Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality and should be treated with iron supplementation in addition to prenatal vitamins. In addition, there may be an association between maternal iron deficiency anemia and postpartum depression, with poor results in mental and psychomotor performance testing in offspring”. Screening for anemia is included in most prenatal lab sets. However, up to 42% of women who enter prenatal care are iron deficient BEFORE anemia is detected. Iron deficiency itself, even without anemia, has also been linked to pregnancy morbidity. The ACOG currently does not have a statement endorsing universal ferritin screening in pregnancy outside of established anemia, but new data is challenging this (Jan 2026, Lancet). Listen in for details. 1. ACOG PB 2332. Wasim T, Bushra N, Nasrin T, Humayun S, Tajammul A, Khawaja KI, Irshad S, Fatima S, Yasin A, Zamora J, Cano-Ibáñez N, Fernandez-Felix BM, Khan KS; Ferritin screening and iron treatment for maternal anaemia and fetal growth restriction prevention (FAIR) Study Group. Intravenous iron for non-anaemic iron deficiency in pregnancy: a multicentre, two-arm, randomised controlled trial. Lancet Haematol. 2026 Jan;13(1):e22-e29. doi: 10.1016/S2352-3026(25)00315-1. PMID: 41482443.3. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2024.15196

Episode 213: HIV PrEP Review H. Nicole Magaña, medical student, reviews the history of PrEP and outlines the currently FDA-approved medications used for HIV prevention. Dr. Arreaza provides additional perspective on long-acting injectable options, including how quickly they begin to protect patients after initiation.   Written by Nicole Magana, MSIV, American University of the Caribbean. Comments and edits 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. Pre-exposure prophylaxis for HIV. Previous episodes related to HIV:  -Episode 67, HIV history (September 2021) -Episode 68, HIV transmissibility (October 2021) -Episode 70 (October 2021), HIV prevention (including HIV Prep with oral medications) -Episode 98 (June 2022), we introduced Apretude, the first injectable for HIV PrEP. Apretude was approved in December 2021.  What is Pre-Exposure prophylaxis (PrEP)? Pre-exposure prophylaxis, or PrEP, is the use of antiretroviral medications taken by individuals who are HIV-negative to prevent HIV acquisition. There are 30,000 new HIV infections annually in the US.  How effective is it? When taken as prescribed, PrEP is highly effective at reducing the risk of HIV transmission through sexual exposure and injection drug use. Patients who are adherent to PrEP can lower their risk of contracting HIV by 99%. The effectiveness of oral PrEP is highly adherence dependent. In trials with 70% adherence, the relative risk of HIV acquisition was 0.27, compared to 0.51 with 40-70% adherence and no significant benefit with adherence ≤40%. How does PrEP work? PrEP works by maintaining therapeutic drug levels in the bloodstream and in target tissues. If HIV exposure occurs, viral replication is inhibited, preventing the establishment of infection. Brief History of PrEP. The concept of PrEP originated from early animal studies demonstrating that antiretroviral medications could prevent retroviral transmission when administered before exposure. In 2010, the iPrEx trial showed that daily oral tenofovir disoproxil fumarate (known as Truvada) with emtricitabine significantly reduced HIV acquisition among men who have sex with men and transgender women. This was the first large clinical trial to demonstrate the effectiveness of PrEP. In 2012, the FDA approved oral Truvada, which is TDF/FTC (tenofovir disoproxil and emtricitabine) for HIV prevention. Since then, additional studies have expanded indications and introduced new formulations, including long-acting injectable options. Who Should Be Offered PrEP? PrEP should be considered for any HIV-negative individual at increased risk of HIV acquisition, including Men who have sex with men, transgender individuals, heterosexual men and women with an HIV-positive partner, individuals with recent bacterial sexually transmitted infections, people who inject drugs, individuals engaging in condomless sex with partners of unknown HIV status. Remember that PrEP should be offered in a nonjudgmental, patient-centered manner, make it a safe space to talk openly about prevention of HIV.  Available HIV PrEP Options. Daily Oral PrEP: There are 2 formulations of Tenofovir. There is Tenofovir disoproxil fumarate (TDF)/ Truvada and Tenofovir alafenamide (TAF)/ Descovy. Each is available in a tablet combined with Emtricitabine a nucleoside reverse transcriptase inhibitor. Truvada: It is approved for all populations at risk through sexual exposure or injection drug use. Something to look out for before starting this medication is for pre-existing CKD. Do not give to patients who have an estimated glomerular filtration rate of less than 60 mL/min. (6) Descovy: This option is approved for men who have sex with men and transgender women but is not approved for individuals at risk through receptive vaginal sex. It has less impact on renal function and bone mineral density compared to Truvada. It can be used in moderately reduced kidney function (GFR between 30-60 mL/min). Truvada and Descovy are taken orally once a day.  After patients start taking these medications, when are they considered to be protected?  Nicole: With daily oral PrEP, guidelines differ with WHO and International Aids Society-USA stating it takes about 7 days, while CDC states 21 days to allow for adequate concentration in tissues (1). Adherence is critical for efficacy. Injectable HIV PrEP. In 2021, the FDA approved the first Injectable PrEP option Long-acting cabotegravir (CAB-LA)- known on the market as Apretude. Cabotegravir is an integrase strand transfer inhibitor administered as an intramuscular injection.Dosing consists of an initial injection, a second injection one month later, and then maintenance injections every two months (1). Another option is Lenacapavir (Yeztugo). The Yeztugo as a pre-exposure prophylaxis (PrEP) for HIV in Oct 2024. Yeztugo is the first and only FDA-approved HIV prevention treatment that requires just two injections per year, offering a long-acting option for people who weigh at least 35kg. It is given as 2 injections every 6 months. First dose is given with 2 tablets on Day 1 and Day 2, then every 6 months 2 injections on the same day. Clinical trials, including HPTN 083 and HPTN 084, demonstrated that injectable cabotegravir is superior to daily oral PrEP in preventing HIV infection. This advantage is largely due to improved adherence rather than differences in intrinsic drug potency. There have been no head-to-head comparisons between Yeztugo and Apretude, but they are both very effective. Apretude starts protecting 7 days after the first dose, and Yeztugo starts protecting 2 hours after Day 2 (if patient takes the oral loading dose) or 3-4 weeks if no oral load is taken. Injectable PrEP is particularly beneficial for patients who struggle with daily pill adherence, have trouble swallowing pills, prefer a discreet option, have difficulty storing their medication or have renal or bone disease that limits the use of tenofovir-based regimens like Truvada and Descovy (6). In one unpublished report by Medline, patients who received Apretude had an increase in bone mineral density compared to those who received Truvada (1). Tests prior to starting PrEP. Before initiating PrEP, patients must be confirmed to be HIV-negative. Baseline evaluation includes HIV testing with a fourth-generation antigen/antibody assay, HIV RNA testing if acute infection is suspected, renal function testing for oral PrEP, Hepatitis B screening, sexually transmitted infection screening, and pregnancy testing when appropriate. PrEP should not be started in individuals with known or suspected acute HIV infection. Monitoring for patients on HIV PrEP. Monitoring typically includes HIV testing every 2 to 3 months, STI screening every 3 to 6 months, renal function monitoring for those on oral PrEP (tenofovir- based), ongoing adherence and risk-reduction counseling. And for injectable PrEP, adherence to the injection schedule is essential, as delayed dosing may increase the risk of resistance if HIV infection occurs. HIV PrEP is not a prevention for other STIs. Screening for STIs and counseling about prevention is essential. Breakthrough HIV infections on PrEP are rare and most often associated with poor adherence or delayed diagnosis. Truvada is more studied in all populations and is considered safe during pregnancy and breastfeeding. There is less data regarding the injectable option in patients who are pregnant, may become pregnant, or whose primary risk factor is injection drug use (1). Injectable PrEP provides an important alternative for patients with chronic kidney disease and bone disease (1). Key Takeaway Pre-exposure prophylaxis is a safe, effective, and evidence-based strategy for HIV prevention. With both daily oral and long-acting injectable options available, PrEP can be individualized to meet patient needs. Normalizing PrEP discussions in clinical practice is essential to reducing new HIV infections and advancing public health goals.  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: Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society–USA Panel. The Journal of the American Medical Association. 2025. Gandhi RT, Landovitz RJ, Sax PE, et al. Long-Acting Lenacapavir Acts as an Effective Preexposure Prophylaxis in a Rectal SHIV Challenge Macaque Model. The Journal of Clinical Investigation. 2023. Bekerman E, Yant SR, VanderVeen L, et al. Pharmacokinetics and Safety of Once-Yearly Lenacapavir: A Phase 1, Open-Label Study. Lancet. 2025. Jogiraju V, Pawar P, Yager J, et al.

Can we finally modulate post-stroke inflammation?

In this episode, Senior Editor Morgane Boillot speaks with Professor Cristina Tassorelli (University of Pavia, Italy) about recent advances in migraine prevention. Together with colleagues, Tassorelli has authored a Review in the journal examining the major developments in migraine-specific pharmacological treatments over the past decade, with a particular focus on therapies targeting the CGRP pathway. In this conversation, they explore what these advances mean for people living with migraine and for clinicians, discuss promising emerging targets for prevention and the future of biomarkers, and consider whether it is time to redefine the goals of migraine prevention with greater ambition. Click here to read the full article: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00477-6/fulltextMedical imaging and theranostics are revolutionising how we diagnose, treat, and understand disease. To meet this moment, The Lancet group is happy to announce the launch of, The Lancet Medical Imaging and Theranostics. You can visit https://www.thelancet.com/medical-imaging-theranostics to learn more.Continue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Dr Eoin Kelleher, anaesthesiologist and expert in sleep and chronic pain, joins eBioMedicine Senior Editor Dr Rida Ansari to discuss the relationship between sleep and chronic pain across the lifespan. The conversation examines biological mechanisms, clinical implications, and everyday relevance, drawing on insights from the paper Why sleep matters in chronic pain: evidence across the lifespan.Click on the link to read the full articles in the eBioMedicine Series on Sleep:Why sleep matters in chronic pain: evidence across the lifespanhttps://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(26)00039-3/fulltextSleep apnea, heart health and testosterone: unravelling the triad of well-beinghttps://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(26)00038-1/fulltextMedical imaging and theranostics are revolutionising how we diagnose, treat, and understand disease. To meet this moment, The Lancet group is happy to announce the launch of, The Lancet Medical Imaging and Theranostics. You can visit https://www.thelancet.com/medical-imaging-theranostics to learn more.Continue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Join the Behind the Knife Surgical Oncology Team as we discuss the PRADO and NADINA randomized control trials regarding neoadjuvant therapy in Stage III melanoma with macroscopic nodal disease!Hosts:Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 2ndYear Surgical Oncology fellow at MD Anderson.Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a General Surgery physician in the United States Air Force station at RAF Lakenheath.Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.Galen Gist, MD (@gistgalen) is a General Surgery research resident between his second and third year at Brooke Army Medical Center. Learning Objectives:-       Evaluate the role of Completion Lymph Node Dissection (CLND) in patients with positive sentinel lymph nodes, specifically citing the lack of melanoma-specific survival benefit vs. the improvement in regional disease control demonstrated in the MSLT-II trial.-       Determine the appropriate surgical excision margins for primary cutaneous melanoma, comparing the outcomes of 1 cm versus 2 cm margins as analyzed in the MINT trial (Lancet 2019).-       Analyze the impact of adjuvant systemic therapy (Anti-PD1/Immunotherapy) on recurrence-free survival in patients with resected high-risk Stage III melanoma.References:Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-xChristian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2*Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.  Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Feeling overwhelmed by conflicting advice about menopause and HRT? You're not alone, and you're not imagining it.In this eye-opening conversation, journalist and author Fiona Clark (MenoWars: Why Menopause's Moment Has Gone Horribly Wrong) joins me to unpack why the menopause conversation has become so polarizing. What started as a grassroots movement of women advocating for better care has evolved into a confusing battlefield of conflicting claims, FOMO-inducing headlines, and monetized advice that leaves women more overwhelmed than empowered.Fiona brings her unique background, which includes a degree in anatomy and physiology, decades as a journalist, and her own experience navigating menopause to help us understand how we got here. We explore the "menopause wars," from the rise of influential voices making claims that science doesn't always support, to the gatekeeping accusations that emerge when medical professionals push back, to the dangerous erosion of trust in evidence-based medicine.In this episode, we talk about:How the menopause advocacy movement transformed from collegial to combativeWhy testosterone has become the latest battleground (and what happened when Fiona stopped taking it)The FOMO epidemic: dementia, heart disease, and what the research actually showsWhy "gatekeeping" accusations undermine the scientific processThe commercialization of menopause and how confusion gets monetizedWhat HRT can (and can't) do, and why cutting out the noise matters more than anythingWhy women deserve to make informed decisions about their bodies without everyone else's opinionsFiona's message is clear: it's not about being pro- or anti-HRT. It's about cutting through the noise, understanding what science actually supports, and reclaiming your right to make informed decisions about your own body without FOMO, fear, or unsolicited opinions.If you've felt confused, frustrated, or exhausted by the menopause information overload, this conversation will help you find your footing.About Fiona: Fiona is an award winning investigative journalist who spent the first 20 years of her career in the Australian Broadcasting Corporation. She covered the 1991 coup in Soviet Union, the Balkans War and went on to be supervising producer of its current affairs equivalent of the BBC Newsnight. Her degree is in Sports Medicine and some 20 years ago she went into medical publishing. She has written for The Lancet and various other medical publications. For the past 8 years she has been working in the menopause space and is the co-founder  of the Menopause Research and Education Fund and the author of MenoWars - a look at the state of women's health through the lens of the current debates in menopause. Connect with Fiona:Book: MenoWars (available on Amazon and UK bookstores)Charity: Menopause Research and Education FundRelated Episodes You'll Love:Brain Health & Menopause: What Science Really SWhat did you think of this episode? Click here and let me know!

Rheumatoid Arthritis explained, including pathophysiology and typical signs and symptoms (extra articular too!). We also look at rheumatoid arthritis diagnosis (with rheumatoid factor / Anti CCP) and medications such as DMARDsPDFs available here: https://rhesusmedicine.com/pages/rheumatologyConsider 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 Rheumatoid Arthritis?0:23 Rheumatoid Arthritis Pathophysiology 2:58 Rheumatoid Arthritis Symptoms5:16 Rheumatoid Arthritis Diagnosis 7:02 Rheumatoid Arthritis Treatment LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesMSD Manual Professional Edition (2025) Rheumatoid arthritis. MSD Manual Professional Edition. Available at: https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/rheumatoid-arthritisBMJ Best Practice (2025) Rheumatoid arthritis – Symptoms, diagnosis and treatment. BMJ Best Practice. Available at: https://bestpractice.bmj.com/topics/en-gb/105Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR. Kelly and Firestein's Textbook of Rheumatology. 11th ed. Elsevier; 2021.McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365:2205–2219.Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388:2023–2038.Abbas AK, Lichtman AH, Pillai S. Cellular and Molecular Immunology. 10th ed. Elsevier; 2021.Kumar V, Abbas AK, Aster JC. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Elsevier; 2020.Please 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. 

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, 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.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! 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:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Chronic diseases like heart disease, diabetes, and obesity are killing more people than ever before. Could your diet be the biggest driver of this risk? Today, Dr Mark Hyman explains why food matters more than genetics for long-term health, and how one diet change can make the biggest difference.  Alongside Professor Tim Spector, Mark, a 15-times New York Times bestselling author and a practising family doctor, explores how modern eating is linked to chronic disease and what the science says reduces risk. We break down how food is designed to make us eat more, how this affects metabolism, insulin and inflammation, and why this matters more than your genes. By the end of the episode, you'll understand the single most important dietary change Mark believes can lower chronic disease risk, based on clinical experience. If the modern world is driving these conditions, what's one small change you can make to take back control of your future health?

Today my guest is Nachiket Mor, a health economist whose work focuses on the design of national and regional health systems. He is a visiting scientist at the Banyan Academy of Leadership in Mental Health, a senior research fellow at the Centre for Information Technology and Public Policy at IIIT Bangalore, and a commissioner and author on the Lancet Citizens' Commission on Reimagining India's Health System, which published its final report in The Lancet in January 2026. We talked about the different layers of the Indian healthcare system, the design and policy failures in both public and private sector healthcare, the role of community workers, the health insurance and regulation market, and much more.  Recorded January 29th, 2026. Read a full transcript enhanced with helpful links. Learn more about The 1991 Fellowship. Connect with Ideas of India Follow us on X Follow Shruti on X Follow Nachiket on X Click here for the latest Ideas of India episodes sent straight to your inbox. Timestamps (00:00:00) - 1991 Fellowship (00:01:11) - Intro (00:02:32) - Policy Design Failure in India's Healthcare System (00:07:43) - Layers of Indian Healthcare (00:14:04) - ASHA Workers (00:23:59) - State Capacity (00:26:47) - The Exit to the Private Sector (00:34:00) - Getting Ambitious with ASHA Workers (00:37:54) - Stacking Healthcare (00:51:53) - India's Private Sector Healthcare (01:05:14) - Government Insurance Instruments (01:13:10) - Insurance Regulation in India (01:41:09) - Outro

  Genes. Glands. Vessels.

Statins are one of the most prescribed drugs in the world as they are highly effective at reducing “bad” LDL cholesterol that causes cardiovascular disease. A new review in the Lancet has found there are far fewer side effects associated with their use than previously thought. New Nipah cases have been reported in India and Bangladesh. Trudie Lang Professor of Global Health Research at the University of Oxford explains the significance and how worried we should be.A team in Cardiff, Wales have designed a reusable sanitary pad that cleans in sunlight. As a trial of the product begins in Nepal, we find out what the participants think of the idea and how it works.What does air pollution do to our bodies? James Gallagher reports. Plus, does pink noise actually help us sleep?Presenter: Laura Foster Producer: Hannah Robins Assistant Producers: Jonathan Blackwell, Anna Charalambou

In this special series on Oral GLP-1 Receptor Agonists, Dr. Neil Skolnik will discuss the first of the GLP-1 RAs to receive FDA approval, Semaglutide.  This special episode is sponsored with support from Novo Nordisk. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health W. Timothy Garvey, MD.,  Butterworth Professor and University Professor of Medicine in the Department of Nutrition Sciences at the University of Alabama at Birmingham. Selected references: Oral semaglutide 50 mg taken once per day in adults with overweight or obesity (OASIS 1): a randomised, double-blind, placebo-controlled, phase 3 trial. Knop, Filip K et al. The Lancet, Volume 402, Issue 10403, 705 – 719 Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity. Wharton Sean et al. N Engl J Med 2025;393:1077-1087 Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. Lincoff, A Michael, et al.  N Engl J Med 2023;389:2221-2232  

Frederico Amorim convida Ayrton Silveira e Flávio Barbieri para falar sobre diagnóstico de arboviroses em 4 partes:- Quando suspeitar?- Diferenças entre as arboviroses (dengue, chikungunya e zika)- Quais exames pedir?- Abordagem geralReferências:1. Pan American Health Organization. Recommendations for Laboratory Detection and Diagnosis of Arbovirus Infections in the Region of the Americas. Washington, D.C.: PAHO; 2023. Available from: https://doi.org/10.37774/9789275125878.2. WHO guidelines for clinical management of arboviral diseases: dengue, chikungunya, Zika and yellow fever. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.3. Rosenberger, Kerstin D et al. “Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study.” The Lancet. Global health vol. 11,3 (2023): e361-e372. doi:10.1016/S2214-109X(22)00514-94. https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/a/aedes-aegypti/monitoramento-das-arboviroses5. Dengue : diagnóstico e manejo clínico : adulto e criança [recurso eletrônico] / Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de Doenças Transmissíveis. 6. ed. – Brasília : Ministério da Saúde, 2024.6. Shahsavand Davoudi, Amirhossein et al. “Ultrasound evaluation of gallbladder wall thickness for predicting severe dengue: a systematic review and meta-analysis.” The ultrasound journal vol. 17,1 12. 3 Feb. 2025, doi:10.1186/s13089-025-00417-57. Shabil, Muhammed et al. “Hypoalbuminemia as a predictor of severe dengue: a systematic review and meta-analysis.” Expert review of anti-infective therapy vol. 23,1 (2025): 105-118. doi:10.1080/14787210.2024.24487218. Tsheten, Tsheten et al. “Clinical predictors of severe dengue: a systematic review and meta-analysis.” Infectious diseases of poverty vol. 10,1 123. 9 Oct. 2021, doi:10.1186/s40249-021-00908-29. Boletim Epidemiológico – Monitoramento das arboviroses e balanço de encerramento do COE Dengue e outras Arboviroses 2024,Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Volume 55, nº 11, 4 jul. 202410. Daumas, Regina P et al. “Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil.” BMC infectious diseases vol. 13 77. 8 Feb. 2013, doi:10.1186/1471-2334-13-7711. Kamble N, Kumar VS, Rangaswamy DR, Kavatagi K. When it itches, dengue switches off: a retrospective case series. Bull Natl Res Cent. 2024;48:68. doi:10.1186/s42269-024-01225-y

Angenommen, Dein Personalausweis sagt, Du bist 46. Dann erzählt Dein Körper vielleicht die Geschichte einer 55-Jährigen – oder die eines 37-Jährigen. Der Unterschied? Dein biologisches Alter. Und das kannst Du beeinflussen.Am Ende dieser Folge weißt Du, was biologisches Alter wirklich bedeutet, wie Du es messen kannst – von DNA-Tests bis Wearables – und welche drei Hebel auf Basis aktueller Forschung am effektivsten sind. Mark teilt seine eigenen WHOOP-Daten aus 2025: vom Bestwert im Sommer über Bundeswehrübung und USA-Jetlag bis zum Buchlaunch-Stress. Das Ergebnis? Trotz allem netto jünger geworden.Du lernst, warum VO₂max der stärkste Prädiktor für Deine Lebenserwartung ist, warum Schlafkonsistenz wichtiger ist als Schlafdauer – und warum 90 Minuten Krafttraining pro Woche Dich um fast 4 Jahre verjüngen können.____________*WERBUNG: Infos zum Werbepartner dieser Folge und allen weiteren Werbepartnern findest Du hier.Nur diese Woche: Sichere Dir Dein #DRNBLBR Gym Towell – solange vorrätig: drnblbr.de.____________Erwähnte Tools und Ressourcen:Fitnesstracker:WHOOP (Fitness-Tracker mit umfassendem Healthspan-Feature) – 1 Monat gratis über diesen Link.Cerascreen Genetic Age Test (epigenetischer Test, Horvath-Uhr)Polar Loop (kein Abo, weniger Funktionen)Amazfit Helio Strap (kein Abo, Basisfunktionen)Waage:Withings Body ScanBücher:„Looking Good Naked – Die Gesamtausgabe“ von Mark Maslow (2025)Podcast und Artikel:Folge 466: Die neue Wissenschaft vom Schlaf – mit Dr. Peter SporkArtikel: Genetic Age Test: Die Wahrheit über Dein biologisches Alter?Testbericht:c't Fitnessarmband-Vergleichstest (Helio Strap, Polar Loop, WHOOP)Forschungseinrichtung:Buck Institute for Research on Aging (Whoop-Forschungspartner)Literatur:Horvath, S. (2013). DNA methylation age of human tissues and cell types. Genome Biology, 14(10), R115.Fitzgerald, K.N. et al. (2021). Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial. Aging, 13(7), 9419–9432.Mandsager, K. et al. (2018). Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open, 1(6), e183605.Windred, D.P. et al. (2024). Sleep regularity is a stronger predictor of mortality risk than sleep duration. SLEEP, 47(1), zsad253.Leong, D.P. et al. (2015). Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet, 386(9990), 266–273.Tucker, L.A. (2024). Telomere Length and Biological Aging: The Role of Strength Training in 4814 US Men and Women. Biology, 13(11), 883.c't Magazin (2025). Fitnessarmbänder ohne Display im Test: Helio Strap, Polar Loop, WHOOP MG. Ausgabe 25, S.102.Produktlinks sind Affiliate-Links.____________Shownotes und Übersicht aller Folgen.Trag Dich in Marks Dranbleiber Newsletter ein.Entdecke Marks Bücher.Folge Mark auf Instagram, Facebook, Strava, LinkedIn. Hosted on Acast. See acast.com/privacy for more information.

Episode 211: Understanding HFpEF.  Hyo Mun and Jordan Redden (medical students) explain the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and how it differentiates from HFrEF. Dr. Arreaza asks insightful questions and summarizes some key elements of HFpEF. Written by Hyo Mun, MS4, American University of the Caribbean; and Jordan Redden, MS4, Ross University School of Medicine. Comments and edits 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 EF? Just imagine, the heart is a pump, blood gets into the heart through the veins, the ventricles fill up and then squeeze the blood out. So, the percent of blood that is pumped out is the EF. Let's start at the beginning. What is HFpEF?Mike: HFpEF stands for heart failure with preserved ejection fraction. Basically, these patients squeeze normally—their ejection fraction is 50% or higher—but here's the thing: the heart can't relax and fill the way it should. The muscle gets stiff, almost like a thick leather boot that just won't stretch. And because the ventricle can't fill properly, pressure starts backing up into the lungs and the rest of the body. That's when patients start experiencing shortness of breath, leg swelling, fatigue—all those classic symptoms.Dr. Arreaza: And this is where people get fooled by the ejection fraction.Mike: Exactly. The ejectionfraction tells you total left ventricular emptying, not just forward flow.Jordan: The classic example is severe mitral regurgitation. You can eject 60% of your blood volume and still be in cardiogenic shock because most of that blood is leaking backward into the left atrium instead of going into the aorta. So, you get pulmonary edema, hypotension, fatigue, all with a “normal” EF. Which is honestly terrifying if you're over-relying on echo reports without thinking clinically.Dr. Arreaza: And in HFpEF, functional mitral regurgitation often shows up later in the disease. It's not usually the primary cause; it's more of a marker of advanced disease. Moderate to severe MR in HFpEF independently predicts worse outcomes, including a higher risk of mortality or heart failure hospitalization. So, let's contrast this with HFrEF. How are these two different?Mike: HFrEF—heart failure with reduced ejection fraction—is a pumping problem. The heart muscle is weak and can't contracteffectively. Ejection fraction drops below 40%, and this is your classic systolic dysfunction.Jordan: HFpEF, on the other hand, is diastolic dysfunction. The heart muscle is thick, fibrotic, and noncompliant. It squeezes fine, but it just doesn't relax, even though the EF looks reassuring on paper.Mike: I like to explain it this way: HFrEF is a weak heart that can't squeeze. HFpEF is a stiff heart that can't relax. Totally different problems.Dr. Arreaza: And then there's the gray zone: heart failure with mildly reduced EF, or HFmrEF. That's an EF between 41 and 49% with evidence of elevated filling pressures. It really shares the features of both worlds. So, what actually causes HFpEF versus HFrEF?Jordan: HFpEF is basically what happens when all the problems of modern living catch up with you. You've got chronic hypertension, obesity, diabetes, metabolic syndrome, aging, systemic inflammation—all of these things slowly remodel the heart over years. The muscle gets thick and stiff, and eventually the ventricle just loses its ability to relax. So, HFpEF is really a disease of metabolic dysfunction and chronic stress in the heart. Mike: HFrEF is more about direct injury. Think about myocardial infarctions, ischemic cardiomyopathy, viral myocarditis, alcohol toxicity, chemotherapy like doxorubicin, genetic cardiomyopathies, or chronic uncontrolled tachycardia. These insults actually damage or kill heart muscle cells, leading to a dilated, weak ventricle that can't pump effectively.Dr. Arreaza: So the short version: HFpEF is caused by chronic metabolic and hypertensive stress, while HFrEF is caused mainly by myocardial damage. A question we get a lot: does HFpEF eventually turn into HFrEF? What do you guys think?Mike: In most cases, no. HFpEF patients usually stay HFpEF throughout their disease course. They don't just “burn out” and turn into HFrEF.Jordan: They're generally separate disease entities with different pathophysiology. A patient with HFpEF can develop HFrEF if they have a big myocardial infarction or ongoing ischemia that damages the muscle, but that's not the natural progression.Mike: Interestingly though, the opposite can happen. Some HFrEF patients actually improve their ejection fraction with good medical therapy—that's called HF with improved EF—and it's a great sign that treatment is working.Dr. Arreaza: Another question. How do HFpEF and HFrEF compare to restrictive cardiomyopathy and constrictive pericarditis?Jordan: Clinically, they can all look very similar: dyspnea, edema, fatigue, but the underlying mechanisms are completely different.Mike: In HFpEF, the myocardium itself is stiff from hypertrophy and fibrosis. The problem is intrinsic to the heart muscle, and EF stays preserved. Echoshows diastolic dysfunction with elevated filling pressures.Jordan: In HFrEF, the myocardium is weak. The ventricle is often dilated and contracts poorly, with a reduced EF.Mike: Restrictive cardiomyopathy is different. Here, the myocardium gets infiltrated by abnormal stuff—amyloid, iron, sarcoid—and that makes it extremely stiff. It can look like HFpEF on the surface, but it's usually more severe. On Echo You'll see biatrial enlargement, small ventricles, and preserved EF. And importantly, it's a pathologic diagnosis, so you need advanced imaging or biopsy to confirm it.Jordan: Constrictive pericarditis is another mimic, but here the myocardium is usually normal. The problem is that the pericardium is thickened, calcified, and rigid. This will physically prevent the heart from being filled. Imaging shows pericardial thickening, septal bounce, and respiratory variation in flow, and cath shows equalization of diastolic pressures, which is the hallmark of constrictive pericarditis.Dr. Arreaza: So the takeaway is: HFpEF is a clinical syndrome driven by common metabolic and hypertensive causes, while restrictive and constrictive diseases are specific pathologic entities. If “HFpEF” is unusually severe or not responding to treatment, you need to think beyond HFpEF. Which type of heart failure is more common right now?Mike: Good question, the answer is: HFpEF. It now accounts for up to 60% of all heart failure cases, and it's still rising.Dr. Arreaza: Why is that?Jordan: Because people are living longer, gaining weight, and developing more metabolic syndrome. HFpEF thrives in older, or people with obesity, hypertension, or diabetes: basically, the modern American population. At the same time, better treatment of acute MIs means fewer people are developing HFrEF from massive heart attacks.Mike: HFpEF is the heart failure epidemic of the 21st century. It's honestly the cardiology equivalent of type 2 diabetes.Dr. Arreaza: Let's talk aboutCOVID-19. (2025 and still talking about it) Does it actually increase heart failure risk?Mike: Yes, absolutely. COVID increases both acute and long-term heart failure risk.Jordan: During acute infection, COVID can cause myocarditis, trigger massive inflammation, and precipitate acute decompensated heart failure, especially in patients with pre-existing disease. It also causes microthrombi, which can injure the myocardium.Mike: And after infection, even mild cases are linked to a significantly higher risk of developing new heart failure within the following year. Both HFpEF and HFrEF rates go up.Dr. Arreaza: I remember seeing this in 2021, we had a patient with acute COVID and HFrEF, her EF was about 10%, I lost contact with the patient and at the end I don't know what happened to her. What's the pathophysiology of COVID and heart failure?Mike: COVID causes direct viral injury through ACE2 receptors, triggers massive inflammation that damages the endothelium and heart muscle, leads to microvascular clotting and fibrosis—all mechanisms that promote HFpEF.Jordan: Add autonomic dysfunction, persistent low-grade inflammation, and worsening metabolic syndrome, and you've got a perfect storm for heart failure.Dr. Arreaza: Bottom line: COVID is a cardiovascular disease as much as a respiratory one. If someone had COVID and now has unexplained dyspnea or fatigue, think about heart failure. Get an echo, get a BNP, start treatment. Last big question: why did we have so many therapies for HFrEF but essentially none for HFpEF for years?Mike: HFrEF is mechanistically straightforward. You've got a weak heart with excessive neurohormonal activation going on — so you block RAAS, block the sympathetic system, drop the afterload. The drugs make sense.Jordan: HFpEF is messy. It's not one disease. It's stiffness, fibrosis, inflammation, microvascular dysfunction, metabolic disease, atrial fibrillation, all overlapping. One drug can't fix all of that.Mike: And some drugs that worked beautifully in HFrEF actually made HFpEF worse. Take Beta blockers, for example.  They slow heart rate, which is a problem because HFpEF patients rely on heart rate to maintain their cardiac output.Jordan: The breakthrough came with SGLT-2 inhibitors: diabetes drugs that unexpectedly addressed multiple HFpEF mechanisms at once: volume, metabolism, inflammation, and myocardial energetics.Dr. Arreaza: The miracle drug for HFpEF! Alright, let's wrap up.Mike: Bottom line: HFpEF is common, complex, and dangerous: even if the EF looks “normal.”Jordan: And if you're relying on ejection fraction alone, HFpEF will humble you every time.Dr. Arreaza: If you liked this episode, share it with a friend or a colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.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:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

En ny norsk-svensk studie publisert i ⁠The Lancet⁠ fant nylig at små og realistiske økninger i fysisk aktivitet på kun fem minutter om dagen, kan forebygge opptil 6 % av alle dødsfall hos de minst aktive. Vi inviterte førsteforfatter Ulf Ekelund i studio for å lære mer om resultatene og metodikken bak studiet. Hvis du er interessert i folkehelse, trening eller har en indre statistikknerd du ikke visste om - så er dette episoden for deg!Videoer fra MedEasy nevnt i episoden:⁠Den beste medisin (effekten av folkehelse)⁠⁠Aterosklerose⁠

Today: a Lancet study puts an AI stethoscope through its paces in 205 London GP surgeries — aiming to catch serious heart conditions earlier. The government's dropped a brand-new National Cancer Plan for England, with big survival targets and big promises. Plus, the International AI Safety Report 2026 lands with fresh warnings about deepfakes and rising risk… before we lighten it up with a next-gen Xbox timeline tease and a look at the Fairphone 6, built for people who'd rather repair than replace. More at standard.co.uk. Hosted on Acast. See acast.com/privacy for more information.

Sa sút trí tuệ - dementia thường được nhiều người xem là hệ quả tất yếu của tuổi già. Nhưng các nghiên cứu mới cho thấy điều này không hoàn toàn đúng. Theo Ủy ban Lancet về sa sút trí tuệ, khoảng 45% các trường hợp trên toàn cầu có thể phòng tránh hoặc trì hoãn, nếu thay đổi lối sống phù hợp.

Jamie Prowse, Senior Editor at The Lancet Oncology, is joined by Dr Dylan Graetz (Department of Oncology and Department of Global Pediatric Medicine, St Jude Children's Research Hospital) and Dr Erica Kaye (Department of Oncology, St Jude Children's Research Hospital) to discuss qualitative in oncology.Read the full Reviews:https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00669-2 for The Power of Words: Evaluating the Role of Qualitative Methods in Cancer Researchand https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00670-9 for Expert Recommendations for the Conduct and Appraisal of Qualitative Research in Oncologyand the reviews in  Lancet Haematology 2026  https://doi.org/10.1016/S2352-3026(25)00321-7and eClinicalMedicine https://doi.org/10.1016/j.eclinm.2025.103736Tell us what you thought about this episodeMedical imaging and theranostics are revolutionising how we diagnose, treat, and understand disease. To meet this moment, The Lancet group is happy to announce the launch of, The Lancet Medical Imaging and Theranostics. You can visit https://www.thelancet.com/medical-imaging-theranostics to learn more.Continue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

En este episodio especial de Radio el Respeto, conversamos en profundidad con el Dr. Alfredo Corell, catedrático de inmunología y una de las voces más reconocibles de la divulgación científica en español tras su trabajo durante la pandemia de COVID-19. Alfredo Corell es inmunólogo, catedrático de universidad y divulgador científico español, miembro de la Sociedad Española de Inmunología. Licenciado y doctor en Biología en la UCM, realizó la especialidad de Inmunología y la tesis doctoral en el Hospital 12 de Octubre de Madrid. Durante 18 años realizó labores investigadoras y de diagnóstico inmunológico en diversos hospitales. Su trabajo en Inmunogenética e Histocompatibilidad incluye el descubrimiento de un pseudogen del cromosoma 6 humano: HLA-DRB6. Tiene más de 80 publicaciones científicas de alto impacto incluyendo las prestigiosas New England Journal of Medicine, Lancet, Immunology Today, Lancet Microbe y Mucosal Immunology. En 1999 se incorporó como profesor de Inmunología en la Universidad de Valladolid, catedrático en 2020 y llegó a Vicerrector de Innovación Docente y Transformación Digital. En marzo de 2023 se incorporó como catedrático a la Universidad de Sevilla y como Inmunólogo al Hospital Virgen del Rocío. Corell es el coordinador del proyecto de innovación docente Immunomedia, una plataforma digital de docencia y divulgación, reconocida tanto nacional como internacionalmente. En su faceta de divulgador científico, ha sido colaborador en La Sexta Noche; La hora de la 1; y Está Pasando. También ha participado en Informe Covid, Horizonte, Cuatro al Día, y Las Cosas Claras, entre otros programas. Ha intervenido frecuentemente en los informativos de canales nacionales, locales y autonómicos. Ha colaborado con periódicos impresos y digitales nacionales y autonómicos, y participa asiduamente en plataformas de desmentidos de bulos sobre salud en Maldita.es, Salud sin Bulos y Newtral. Su compromiso con el colectivo LGTBi ha sido reconocido con el premio Triángulo Rosa de la Fundación Triángulo de Castilla y León (2019), Premio “Baeza diversa” (2023) y siendo incluido en la lista de las 100 personalidades españolas LGTBI más influyentes (El Mundo y El Español). Ha recibido diversos reconocimientos como: en 2021 el Premio Innovador al Personaje Único (periódico El Mundo de Castilla y León), Primer Premio CSIC-Fundación BBVA a la Comunicación Científica, o su inclusión en la lista Forbes entre los 100 españoles más creativos del mundo empresarial, en 2022 el Premio Orgullo Friki e Influencers awards de ciencia (revista Influencers), y en 2024 el Premio a la Excelencia Comunicativa de Servicio Público (UVa), y Premio Merco-OdS al Liderazgo Reputacional en la Divulgación Sanitaria. Acaba de publicar su nuevo libro "Inmunidad en Forma", (lo podéis adquirir aquí https://amzn.to/49ISZ0H) en el que Corell nos ofrece una guía completa y práctica sobre el sistema inmunitario: qué es, cómo funciona, qué podemos hacer para cuidarlo y qué NO funciona a pesar de lo que nos venden. Con rigor científico, pero con un lenguaje cercano, desmonta mitos y nos da herramientas reales basadas en evidencia. Lo que exploramos en esta conversación: ¿Qué son realmente las defensas? - Cómo funciona el sistema inmunitario en términos simples - Por qué las mujeres tienen sistemas inmunitarios más potentes pero más autoinmunidad - El papel del intestino: ¿por qué el 70-80% de nuestro sistema inmunitario está ahí? - La inmunosenescencia: cómo envejece nuestro sistema inmunitario ¿Podemos mejorar nuestras defensas? - Nutrición: qué comer (y qué evitar) para cuidar nuestra inmunidad - Vitamina D, C, zinc: ¿qué funciona realmente y qué es mito? - Ejercicio físico: beneficios y el peligro del sobreentrenamiento - Estrés y relaciones sociales: por qué la soledad es tan dañina como fumar 15 cigarrillos al día - Sueño: la epidemia silenciosa que está debilitando nuestras defensas - Tabaco, alcohol y drogas: efectos devastadores en el sistema inmunitario - Tecnología: cómo el uso de pantallas afecta indirectamente nuestra inmunidad Cuando las defensas fallan - Enfermedades autoinmunitarias: ¿por qué el cuerpo se ataca a sí mismo? - Alergias en aumento: la hipótesis de la higiene - Inmunodeficiencias y la revolución del tratamiento del VIH - Vacunas: desmontando mitos y entendiendo la ciencia detrás de ellas - La experiencia personal de Alfredo durante la pandemia Los inmunotimos: desenmascarando productos sin evidencia Síguenos en Redes Twitter: https://twitter.com/radioelrespeto Instagram: https://www.instagram.com/radioelrespeto/ Facebook: https://www.facebook.com/radioelrespeto Redes Sociales del Equipo: | Pablo Fuente | https://www.instagram.com/pablofuente/ | Nacho Sevilla | https://twitter.com/nachorsevilla | Fernando Sierra | https://twitter.com/Peeweeyo1

I know 2026 feels like it ihas been here for months, but only a few weeks ago we were celebrating the nephrology accomplishments of 2025. The New Filtrate came together to review the year.The FiltrateJoel Topf‍ ‍@kidneyboy.bsky.social‬ (COI)Swapnil Hiremath @hswapnil.medsky.social and on LinkedIn Editor in Chief of Kidney International Case ReportsAnna Gaddy (@AnnaGaddy) Winner of NephJC Rookie of the Year 2020Nayan Arora (@CaptainChloride.bsky.social)AC (@medpeedskidneys.bsky.social)Vipin Verghese (@vipvargh.bsky.social) co-winner of NephJC Engaged Scientist of the Year in 2021Brian Rifkin (@brianrifkin.bsky.social) Co-Editor in Chief NephJC. Winner of NephJC Rookie of the Year 2021Cristina Popa (@NephroSeeker) Co-Editor in Chief NephJC. Wwinner of NephJC Rookie of the Year 2022 and MVP 2023Editing and Show Notes byAnna Gaddy and Joel TopfThe Kidney Connection written and performed by Tim YauShow NotesTop Stories in Nephrology 2025 (NephJC)First Top sories in Nephrology 2010! (Renal Fellow Network)Links to all of the Top Stories in Nephrology, hosted on NephJC since 2017 (NephJC)1. IgA NephropathyVISIONARY: Sibeprenlimab in IgA Nephropathy — Interim Analysis of a Phase 3 Trial (NEJM)ORIGIN 3: A Phase 3 Trial of Atacicept in Patients with IgA Nephropathy (NEJM)APPLAUSE-IgA Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy (NEJM)Aliza M. Thompson, MD, MS (ASN) 2. Lupus NephritisREGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis (NEJM)3. Nobel prize winner and peripheral immune tolerance4. Xenotransplantation5. GLP1ra RevolutionRemodel REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide (Kidney International)SURPASS-CVOT Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases (Kidney Week abstract in JASN)Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford (KFF survey)6. GDMT implementation in CKD: lessons learnt from CONFIDENCE and MIRO-CKDConfidence Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes (NEJM)MIRO-CKD Balcinrenone in combination with dapagliflozin compared with dapagliflozin alone in patients with chronic kidney disease and albuminuria: a randomised, active-controlled double-blind, phase 2b clinical trial (The Lancet)7. Flozin Meta analysisSMART-C. SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria. A Meta-Analysis (JAMA)SMART-C. Effects of Sodium Glucose Cotransporter 2 Inhibitors by Diabetes Status and Level of Albuminuria. A Meta-Analysis (JAMA)8. Paradigm Shift: Aiming for CKD Remission9. Fish Oil and DialysisPISCES Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis (NEJM)10. Decline in Dialysis Patients in the United StatesUSRD 2025 Annual Data Report (USRDS)Tubular SecretionSwapnil Hiremath Alien Earth on FX Hulu (Wikipedia)AC A Christmas Carol by Charles Dickens (Wikipedia) and The Muppet Christmas Carol (Wikipedia)Anna Monty Don (Wikipedia)Nayan Back Street Boys at The Sphere (Wikipedia)Brian Marty Supreme (Wikipedia)Cristina The Yellow Tie (Wikipedia)Vipin Stranger Things, good for a four year old? (Wikipedia)Joel Crash Course: The Universe with Katie Mack and John Green (Apple PodCasts)

As Trump surges his Gestapo and threatens to annex new territory, his brain is collapsing. He's sundowning on Truth Social, nodding off in meetings, slurring words, slurping at the saliva pooling in his mouth. His insults and aggressions are as constant and predictable as his arms are, reaching out for handholds. Up until this point, discourse on the mental health of this decrepit fascist leader has used the kid gloves of psychology, psychoanalysis, and psychiatry, in which even the most informed analyses were constrained by the fact that experts were interpreting his inner states. For our part, we've compared his fate to that of charismatic cult leaders at the end of the line—and we'll do more of that today. Now a new posse of clinical commentators on IG and TikTok have made it all much more biological: we are witnessing, they say, the predictable signs of fast-progressing dementia. Show Notes Goldwater Rule vs Duty to Warn, American Academy of Psychiatry and Law World Health Organization: Dementia Signs and Symptoms of Dementia Alzheimer's disease: a comprehensive review of epidemiology, risk factors, symptoms diagnosis, management, caregiving, advanced treatments and associated challenges USC study finds new evidence linking dementia to problems with the brain's waste clearance system A new drug could stop Alzheimer's before memory loss begins A 2025 update on treatment strategies for the Alzheimer's disease spectrum Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission Broadening dementia risk models: building on the 2024 Lancet Commission report for a more inclusive global framework Study finds disparities in diagnosis and treatment of dementia Decomposing Racial and Ethnic Disparities in Risk and Protective Factors of Dementia in the U.S. Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review Dementia Diagnosis Disparities by Race and Ethnicity Racial disparities in dementia determined by social factors Straight-forward Explainer: What's Going on With NIH Cuts to Alzheimer's Research? Learn more about your ad choices. Visit megaphone.fm/adchoices

Most medical encounters are structured as transactions. The patient comes in with a specific complaint, the medical expert identifies a discrete problem, and a specific intervention is prescribed.But at the heart of a medical encounter is a story. When a patient comes in with a medical problem, the problem cannot be disentangled from their life's narrative — doing so risks hollowing out the essence of what it means to care for another person. Our guest on this episode is award-winning author, and primary care physician Suzanne Koven, MD. Following the completion of her residency at Johns Hopkins Hospital, Dr. Koven joined the faculty at Harvard Medical School and practiced primary care medicine at Massachusetts General for 32 years. In 2019, she became the inaugural Writer in Residence at Mass General. Her writings have been published broadly—including in The Boston Globe, The New England Journal of Medicine, The Lancet, and The New Yorker. As a teacher and public speaker, she highlights the relationship between literature and medicine, and is a powerful advocate for female medical trainees. In this episode, Dr. Koven shares her journey to medicine at a time when few women were represented in the field and why she finds her undergraduate English classes to be more relevant to her clinical work than her science classes. We discuss narrative medicine, its value to patients and physicians alike, and how the modern healthcare system struggles to value the patient story. Finally, Dr. Koven leaves us with her advice for up-and-coming trainees: find a place in medicine where you can be yourself – for your own good and for your patients'.In this episode, you'll hear about: 3:00 - Dr. Koven's motivations for going into primary care medicine 15:49 - The impact that Dr. Koven's English degree has had on her approach to medicine 19:36 - What narrative medicine is 24:34 - What is lost when human connection and human story are deprioritized within the practice of medicine 31:15 - The benefits doctors experience when cultivating an appreciation for the arts37:21 - How gender representation in medicine has shaped Dr. Koven's experience as a physician42:54 - The need for the culture of medicine to adapt to changing demographics in the medical workforceIf you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor's Art Podcast 2026

A large Lancet meta-analysis found no clinically meaningful association between prenatal acetaminophen exposure and autism, ADHD, or intellectual disability after restricting analyses to adjusted and sibling-comparison studies, with odds ratios essentially null; acetaminophen remains first-line for pain and fever in pregnancy. A Nordic BMJ case-control study of more than 17,000 gastric cancer cases found no increased risk of non-cardia adenocarcinoma with long-term proton pump inhibitor use after comprehensive confounder adjustment. Finally, a U.S. cohort study of older adults linked shingles vaccination to lower inflammation and slower biological aging across multiple systems, though causality cannot be confirmed due to observational design.

Welcome to another transformative episode of the “Master Instructor Roundtable.” In this discussion, hosts Wendy Batts, and Marty Miller, break down a vital topic every fitness professional and enthusiast needs to hear: Why **strength** should be treated as a key vital sign for longevity and overall health.

D'abord, oui, on le sait désormais, l'allaitement maternel diminue légèrement, mais réellement, le risque de cancer du sein — et cet effet protecteur augmente avec la durée totale d'allaitement au cours de la vie.La preuve la plus souvent citée vient d'une méta-analyse géante publiée dans The Lancet : elle regroupe les données individuelles de 47 études menées dans 30 pays, soit plus de 50 000 femmes atteintes d'un cancer du sein comparées à près de 97 000 femmes non atteintes.Conclusion : le risque relatif de cancer du sein diminue d'environ 4,3% pour chaque 12 mois d'allaitement, et cela en plus de la baisse de risque déjà associée au fait d'avoir eu des enfants. Autrement dit : l'allaitement n'est pas un “bouclier magique”, mais il contribue à réduire le risque, de façon dose-dépendante (plus longtemps = plus protecteur).Pourquoi l'allaitement protège ?Plusieurs mécanismes biologiques sont proposés :pendant l'allaitement, certaines hormones (notamment les œstrogènes) sont plus basses, ce qui réduit la stimulation hormonale du tissu mammaire ;la grossesse et l'allaitement entraînent une maturation des cellules mammaires, qui les rendrait moins susceptibles de devenir cancéreuses ;après l'allaitement, la “remise à zéro” du tissu mammaire (involution) éliminerait aussi certaines cellules potentiellement anormales.Est-ce vrai pour tous les cancers du sein ?L'effet protecteur semble particulièrement marqué pour certains sous-types, notamment les cancers dits hormono-négatifs, comme le triple négatif (plus agressif, plus fréquent chez les femmes jeunes). Une méta-analyse (Annals of Oncology, 2015) retrouve justement une association protectrice plus nette pour ces formes-là. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this episode of Communicable, Josh Davis (Newcastle, Australia) and Emily McDonald (Montreal, Canada), plus invited guest, Steven Tong (Melbourne, Australia)—all practicing physicians and clinical trialists—assemble to discuss some of their ‘top infectious diseases papers published in 2025'. Bassam Ghanem (Jeddah Lol, Saudi Arabia), whom one might know better as Antibiotic Steward on social media, was also invited to share his favourite publications of 2025.Six papers that were most consistently picked by the panel are presented, explaining why they were picked and how they have shifted paradigms or changed their practice. This episode complements the previous episode, which presented ‘top clinical microbiology papers in 2025', and was peer reviewed by Akshatha Ravindra of Kasturba Medical College, Manipal, India.   ResourcesCLARITY initiative websitePapers presented (in order of presentation) Turner NA, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia. JAMAMeya DB, et al. Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis. NEJMVodstrcil LA, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. NEJMKreimer A, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. NEJMGuglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. NEJMRoss JDC et al, Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1). Lancet  ‘One liners' (in order of presentation)Burdet C et al. Cloxacillin versus cefazolin for meticillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa). LancetLemiale V et al, Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC). Lancet Respir MedLuetkemeyer AF et al, Doxycycline to prevent bacterial sexually transmitted infections in the USA. Lancet Inf DisEyting M, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. NatureXie M, et al. The effect of shingles vaccination at different stages of the dementia disease course. CellPomirchy M, et al. Herpes Zoster Vaccination and Dementia Occurrence. JAMADurbin AP et al, Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human Infection Model. NEJMHook EW et al, One Dose versus Three Doses of Benzathine Penicillin G in Early Syphilis. NEJMOpdam MAA et al, Continuation versus temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases. Clin Infect DisArundel C et al, Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2). LancetHonourable mentionsChaccour C, et al. Ivermectin to Control Malaria. NEJMLucinde RK, et al. A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. NEJMMorel J, et al. Effect of a 1-month methotrexate delay on pneumococcal vaccine immunogenicity and disease control in patients with early rheumatoid arthritis (VACIMRA). Lancet RheumatolHaukoos J, et al. Hepatitis C Screening in Emergency Departments. JAMAMajor Extremity Trauma Research Consortium (METRC). Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial, JAMA SurgAnderson CS, et al. Influenza vaccination to improve outcomes for patients with acute heart failure (PANDA II). LancetSt Peter SD, et al. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children. LancetPan CQ, et al. Tenofovir and Hepatitis B Virus Transmission During Pregnancy. JAMAGohil SK, et al. Improving Empiric Antibiotic Selection for Patients Hospitalized With Abdominal Infection. JAMA SurgRelated podcast episodesCommunicable E44: Top clinical microbiology papers in 2025 https://share.transistor.fm/s/6e5c26aeCommunicable E29: Bacterial vaginosis & male partners, https://share.transistor.fm/s/3de4f5c3 Communicable E28: Late-breaker trials at ESCMID Global: Should they change your practice? - part 2, https://share.transistor.fm/s/4f044e8c Communicable E20: Tuberculosis today https://share.transistor.fm/s/9858900e 

Welcome to the “Better Than Fine Podcast!”In this highly informative episode, host Darlene Marshall dives deep into the real story behind **ultra processed foods**, breaking down the latest research from top scientific journals—including a brand-new series from The Lancet. **What You'll Learn:** - The *four categories* of the NOVA food scale and why not all “processed” foods are created equal - How ultra processed foods drive **obesity**, heart disease, type 2 diabetes, cancer, and even depression - The shocking influence of *food industry lobbying and marketing*—and why your cravings might not be about “willpower” at all - Simple, actionable ways to cut ultra processed foods from your diet, support local farmers, and reclaim control over your health—even when access is limited **Why Listen/Watch?** If you care about your **well-being**, **mental health**, or want science-based answers to what's REALLY making our society sick, this episode is for you. [John Jewett](/speakers/A) doesn't just react to headlines—he reviews breakthrough studies, responds to common criticisms, and offers empowering solutions.

Ursodiol (ursodeoxycholic acid) is a prescription bile acid medication used to dissolve cholesterol gallstones, prevent gallstones during rapid weight loss, and treat liver diseases like primary biliary cholangitis (PBC) by reducing toxic bile acids and cholesterol production. It works by changing bile composition, making it less saturated with cholesterol, and is available as oral medication. Of course, it is also the foundational medication for treatment of diagnosed Intrahepatic Cholestasis of Pregnancy (ICP). Does this medication reduce adverse perinatal outcomes? In this episode, we will review a new study from the Green Journal, which will be out in February 2026, examining the recurrence risk for ICP using data from NY. In a patient with prior history of ICP, is there any guidance on monitoring of serum bile acids in the subsequent pregnancy before symptoms develop? We will explain. PLUS we will review the data on whether Ursodiol may hold promise in recurrence prevention or in reduction of adverse outcomes once the condition is diagnosed. Listen in for details. 1. 2019: Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, Hunter R, Dorling J, Williamson C, Thornton JG; PITCHES study group. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019 Sep 7;394(10201):849-860. doi: 10.1016/S0140-6736(19)31270-X. Epub 2019 Aug 1. PMID: 31378395; PMCID: PMC6739598. https://pubmed.ncbi.nlm.nih.gov/31378395/2. February 08, 2025: Rahim, Mussarat N et al. Pregnancy and the liver. The Lancet. 2021; Volume 405, Issue 10477, 498 – 513 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02351-1/fulltext3. SMFM CS 53; 20214. Rosenberg, Henri M. MD; Sarker, Minhazur R. MD; Ramos, Gladys A. MD; Bianco, Angela MD; Ferrara, Lauren MD; DeBolt, Chelsea A. MD. Intrahepatic Cholestasis of Pregnancy Recurrence in a Subsequent Pregnancy. Obstetrics & Gynecology 147(2):p 239-241, February 2026. | DOI: 10.1097/AOG.0000000000006033 https://journals.lww.com/greenjournal/fulltext/2026/02000/intrahepatic_cholestasis_of_pregnancy_recurrence.13.aspx5. Ovadia C, Sajous J, Seed PT et al. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2021 Jul;6(7):547-558. doi: 10.1016/S2468-1253(21)00074-1. Epub 2021 Apr 27. PMID: 33915090; PMCID: PMC8192305.6. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. European Association for the Study of the Liver; 2023

Chronic kidney disease (CKD) now affects about 788 million adults worldwide, more than double the number in 1990, making it one of the most widespread and underrecognized health threats A recent systematic analysis published in The Lancet revealed that CKD is now the ninth leading cause of death globally, responsible for roughly 1.48 million deaths in 2023 alone High blood sugar, elevated blood pressure, and excess body weight are the leading drivers of CKD worldwide, together accounting for most of the disease's overall health burden Early-stage CKD affects over 13% of the adult population globally, yet most cases remain undiagnosed because symptoms often don't appear until the disease is advanced You can lower your risk of CKD by keeping your blood pressure and blood sugar in check, getting regular movement, staying hydrated, reducing processed foods, and supporting kidney function with balanced nutrition

This week Jason Socrates Bardi joins in to talk about about the rivalry between three mathematicians that defined the fifty years surrounding World War I.About our guest:Jason Socrates Bardi is an award-winning journalist in DC who has written two books about the history of math: The Calculus Wars and The Fifth Postulate. He has published hundreds of articles about modern science and medicine in outlets including the San Francisco Chronicle, Good Morning America, US News & World Report, and The Lancet. He lives in Bethesda, Maryland.

A new landmark report has found there is no link between pregnant women taking paracetamol and a child developing autism and/or ADHD. The Lancet study contradicts the US administration’s advice last year when they warned women to stop taking paracetamol because of risks to their unborn child. In this episode of The Briefing, Natarsha Belling, is joined by leading child disability expert Professor Helen Leonard, who explains what this latest study means and the new advice for pregnant women. Headlines: A watered-down version of hate crime laws has passed its first hurdle in Parliament, there's been a fourth confirmed shark attack in NSW in just 48 hours, and the Bureau of Meteorology has issued an aurora alert amid a rare surge in solar activity. Follow The Briefing: TikTok: @thebriefingpodInstagram: @thebriefingpodcast YouTube: @TheBriefingPodcastSee omnystudio.com/listener for privacy information.

El programa '¡Buenos días, Javi y Mar!' en CADENA 100 informa sobre la recomendación de Exteriores para que los españoles en Irán abandonen el país, ante las protestas con más de 2000 muertos reconocidos y cortes de internet. En Burgos, un error en la preparación de un medicamento causa la muerte de dos pacientes oncológicos y afecta a tres, con la Asociación del Defensor del Paciente pidiendo el cese del gerente. Adolescentes de Haro, La Rioja, manipulan fotos de compañeras con IA para crear contenido sexual, lo que lleva a una investigación escolar. Un estudio publicado en The Lancet revela que cinco minutos de ejercicio moderado diario reducen la mortalidad adulta en un 10%. Además, se discute sobre la huelga de médicos que exige un estatuto propio y la ayuda del Ministerio de Cultura de un millón de euros para salas de música en directo. El programa también destaca la historia de una mujer que da a luz en un cine, recibiendo su hija entradas gratis de por vida. Los oyentes ...

Kyle welcomes Dr. Andrew Wakefield, a controversial figure known for his claims linking the MMR vaccine to autism. Wakefield shares his journey from a traditional medical background to becoming a prominent critic of vaccines. The podcast covers the initial study published in The Lancet, its subsequent backlash, and Wakefield's journey through public and professional challenges. Wakefield discusses his transition to filmmaking as a means to spread his message, highlighting his documentary 'Vaxxed' and other key works. The conversation delves into the impact of vaccines on public health, the introduction and potential risks of mRNA vaccines, and broader issues surrounding vaccine policies and public trust. Highlighted are the testimonies of parents with vaccine-injured children, the legal and scientific battles against the mainstream medical community, and the importance of public awareness. The podcast also explores alternative treatments for vaccine-related injuries, emphasizing gut health and the potential benefits of cannabinoids. Dr. Wakefield expresses hope for more informed public health policies and discusses his plans for future projects, including a film addressing the long-term impacts on children left behind by vaccination policies.   Connect with Andy here: Website - Wakefield Media Group Instagram   From Kyle: The Community is coming! Click here to learn more Full Temple Reset is back with Erick Godsey, Click here to learn more   Our Sponsors: Let's level up your nicotine routine with Lucy. Go to Lucy.co/KKP and use promo code (KKP) to get 20% off your first order. Lucy offers FREE SHIPPING and has a 30-day refund policy if you change your mind. These are the b3 bands I was talking about. They are amazing, I highly recommend incorporating them into your movement practice. Go to tonum.com/KKP, use the code KKP, and get 10% off your first order of Nouro.   Connect with Kyle: I'm back on Instagram, come say hey @kylekingsbu Twitter: @kingsbu Our Farm Initiative: @gardenersofeden.earth Odysee: odysee.com/@KyleKingsburypod Youtube: https://www.youtube.com/@Kyle-Kingsbury Kyle's Website: www.kingsbu.com - Gardeners of Eden site If you enjoyed this podcast, please subscribe & leave a 5-star review with your thoughts!

Big Food now supplies over half of U.S. adults' at-home calories through ultraprocessed foods and, according to a study in The Lancet, these foods are now a major global health threat driving chronic disease The NOVA food classification groups foods by processing. Group 4 (ultraprocessed products) are industrial formulations that displace healthy diets and seriously harm health Across 104 studies, higher ultraprocessed food intake was consistently linked to poorer metabolic health, faster weight gain, diabetes, cardiovascular disease, cancer, and long-term exposure to harmful additives and endocrine-disrupting chemicals Most governments rely on weak, nutrient-focused policies and voluntary programs, while industry interference and trade challenges block stronger rules that reduce availability, marketing, and additives in ultraprocessed foods Transnational food giants shape laws, research, and public opinion to protect profits, so personal control starts with awareness, cleaning your pantry, smarter swaps, limiting vegetable oils, and strong social support

I am thrilled to have Dr. Ken Berry joining me on the podcast for the third time today. He was with me before on episodes 111 and 139. Dr. Berry is a physician, best-selling author, and passionate health advocate with a no-nonsense approach to health and wellness. He has been practicing at the Berry Clinics since 2003 and is an active community member. He has written two books, Lies My Doctor Told Me and the recently published Kicking Ass After Fifty, in addition to various other resources, including Common Sense Labs Today. He also has a YouTube channel, serving over 2 million subscribers- one of my favorite go-to resources for my patients.  In our conversation today, we dive into the latest Lancet research on the impact of a diabetes diagnosis on life expectancy, along with insights from the American Diabetes Association regarding the costs of diabetes care. We discuss the need for proper diagnostic modalities to identify insulin resistance earlier and the labs Dr. Berry uses in his practice for identifying those at risk. We explore the recently recognized American Heart Association syndrome, CKM (Cardiovascular Kidney Metabolic Syndrome), and the role of GLP agonists, continuous glucose monitors, and glucometers. Dr. Berry also shares his views on plant-based diets, proper diets, and more.  IN THIS EPISODE YOU WILL LEARN: Why does metabolic health continue to deteriorate in most of the general population?  The staggering amount of disposable plastic used within the healthcare industry The importance of fasting insulin levels when diagnosing metabolic disease Why are blood tests essential for determining metabolic health? The benefits of glucometers and continuous glucose monitors for metabolic health How Dr. Berry's health improved after following a specific diet and measuring his lab results for a month How misinformation gets spread within the health and wellness industry Why are doctors not informing their patients about the absence of long-term studies and deluding them with false information? The long-term effects of Semaglutide on the body  How a proper diet can naturally lower lipid levels The limitations of the germ model for treating chronic diseases  Connect with Cynthia Thurlow Follow on X, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Join other like-minded women in a supportive, nurturing community (The Midlife Pause/Cynthia Thurlow)  Cynthia's Menopause Gut Book is on presale now! Cynthia's Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Ken Berry On ⁠YouTube⁠ ⁠Instagram⁠, ⁠Facebook⁠ ⁠Twitter⁠ Dr. Berry's books ⁠Lies My Doctor Told Me⁠  ⁠Kicking Ass After 50⁠    ⁠Common Sense Labs⁠  Dr. Berry's Private Community ⁠Phdhealth.community⁠ Medical News article Mentioned ⁠Here's What to Know About Cardiovascular-Kidney-Metabolic Syndrome, Newly Defined by the AHA ⁠  Previous Episodes Featuring Dr. Ken Berry ⁠Ep. 111 – Is The Keto Diet The Proper Human Diet? – with Dr. Ken Berry⁠ ⁠Ep. 139 – Hyperinsulinemia: What You Should Know About This National Health Crisis with Dr. Ken Berry

Dry January often raises big questions: how much alcohol is actually safe, and do you need to stop drinking altogether to protect your health? In this episode, world-leading alcohol expert Professor David Nutt explains why alcohol ranks as one of the most harmful drugs to society, how even “normal” drinking can affect your health, and what the science really says about cutting back without giving it up completely. David, a neuropsychopharmacologist and former UK government drug adviser, explains why alcohol was ranked the most harmful drug overall in a landmark comparison of 20 drugs, how harm rises sharply as drinking increases, and unpacks common beliefs like red wine being “good for you”. The conversation also covers the social benefits of alcohol and why the goal isn't necessarily to stop drinking, but to drink with awareness. If you drink at all - whether it's a glass most nights or more on weekends - this episode helps you understand where the real risks begin, and how to make alcohol work for you, not against you. And for listeners using dry January as a reset, David shares practical, science-based advice on how to cut down safely and sustainably. If you're pausing and reflecting this dry January, what might change when you start drinking again? And which habits are worth leaving behind for good? Unwrap the truth about your food

Currently, as of today's date, neither the ACOG nor SMFM currently support routine early induction of labor for suspected fetal macrosomia, instead recommending individualized counseling and reserving elective cesarean for extreme estimated fetal weights. However, a 2025 multicenter, open-label, randomized controlled trial was published in the Lancet comparing induction of labor versus standard care in pregnant women with fetuses suspected to be large for gestational age. The study used a parallel-group design with 1:1 randomization, enrolling women from 106 NHS hospitals across England, Scotland, and Wales. The per-protocol analysis demonstrated a significant reduction (40%) in shoulder dystocia with induction of labor at 38- 38 weeks and 4 days. Is this in conflict with the ACOG current guidance? In this episode, we will review the “Big Baby study” from the Lancet and provide 3 main limitations of this very large study, review the importance of PP vs ITT results, and explain why more data is still needed. Listen in for details. 1. ACOG PB 178; 2017 (reaffirmed 2024)2. Gardosi J, Ewington LJ, Booth K, Bick D, Bouliotis G, Butler E, Deshpande S, Ellson H, Fisher J, Gornall A, Lall R, Mistry H, Naghdi S, Petrou S, Slowther AM, Wood S, Underwood M, Quenby S. Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial. Lancet. 2025 May 17;405(10491):1743-1756. doi: 10.1016/S0140-6736(25)00162-X. Epub 2025 May 1. PMID: 40319899.3. Blaauwgeers, Anne N et al. Rethinking induction of labour for LGA fetuses: the Big Baby trial. The Lancet, Volume 406, Issue 10512, 1562

In mid-December 2025, the FDA approved an at home devicethat aims to treat depression by sending electric current into a part of the brain (the prefrontal cortex) known to regulate mood. This has been available in the UK since 2019 but it is new to the US. The manufacturer has stated that over 55,000 patients have used the device across Europe, the UK, Switzerland, and Hong Kong. How does this work? Is there data to support this new therapy? In this episode, we will summarize three consecutive years of data (2023, 2024,2025) to answer that question. Listen in for details. 1.     Sci Amer: https://www.scientificamerican.com/article/u-s-approves-first-device-to-treat-depression-with-brain-stimulation-at-home/2.     August 12, 2023: Burkhardt, Gerrit et al.Transcranial direct current stimulation as an additional treatment to selectiveserotonin reuptake inhibitors in adults with major depressive disorder inGermany (DepressionDC): a triple-blind, randomised, sham-controlled,multicentre trial The Lancet, Volume 402, Issue 10401, 545 – 5543.     October 21, 2024: Woodham, R.D., Selvaraj, S.,Lajmi, N. et al. Home-based transcranial direct current stimulation treatmentfor major depressive disorder: a fully remote phase 2 randomizedsham-controlled trial. Nat Med 31, 87–95 (2025). https://doi.org/10.1038/s41591-024-4.     December 15, 2025: Moshfeghinia R, Bordbar S,Roointanpour Y, Arab Bafrani M, Shalbafan M. Efficacy and safety of home-basedtranscranial direct current stimulation (tDCS) on patients with depressivedisorders: a systematic review and meta-analysis of randomized clinical trials.Sci Rep. 2025 Dec 15;15(1):43850. doi: 10.1038/s41598-025-28648-5. PMID:41398008; PMCID: PMC12705823.

Peripheral artery disease has been called the ‘silent circulatory crisis'—affecting millions, limiting mobility, and quietly raising the risk of heart attack, stroke, and limb loss. For decades, treatment focused on walking programs, aspirin, and sometimes a stent or bypass. But today, the landscape is changing. From PCSK9 inhibitors that drive cholesterol to record lows, to GLP-1 agonists like semaglutide improving walking distance, to novel antithrombotic strategies that balance bleeding and clotting—PAD care is entering a new era. In this episode, we'll explore the breakthroughs, the evidence behind them, and what they mean for patients who just want to keep moving forward." Hosted by the University of Michigan Department of Vascular Surgery: - Robert Beaulieu, Program Director - Frank Davis, Assistant Professor of Surgery - Luciano Delbono, PGY-5 House Officer - Andrew Huang, PGY-4 House Officer - Carolyn Judge, PGY-2 House Officer Learning objectives:  1.  Describe the current evidence-based recommendations for multifactorial medical management of peripheral artery disease (PAD), including lipid, glycemic, and antithrombotic strategies per 2024 SVS/AHA guidelines.  2. Interpret the clinical implications of the FOURIER trial regarding the role of PCSK9 inhibition in reducing cardiovascular events in patients with atherosclerotic disease, including PAD.  3.  Evaluate the emerging role of GLP-1 receptor agonists, such as semaglutide, in improving walking performance and quality of life among patients with diabetic PAD based on findings from the STRIDE trial. Sponsor URL: https://www.goremedical.com/ References:  H. L. Gornik et al., “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease,” JACC, vol. 83, no. 24, pp. 2497–2604, June 2024, doi: 10.1016/j.jacc.2024.02.013. L. Mazzolai et al., “2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM),” Eur Heart J, vol. 45, no. 36, pp. 3538–3700, Sept. 2024, doi: 10.1093/eurheartj/ehae179. https://pubmed.ncbi.nlm.nih.gov/40169145/ M. S. Sabatine et al., “Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease,” N Engl J Med, vol. 376, no. 18, pp. 1713–1722, May 2017, doi: 10.1056/NEJMoa1615664. https://pubmed.ncbi.nlm.nih.gov/28304224/ M. P. Bonaca et al., “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial,” Lancet, vol. 405, no. 10489, pp. 1580–1593, May 2025, doi: 10.1016/S0140-6736(25)00509-4. https://pubmed.ncbi.nlm.nih.gov/40169145/ N. E. Hubbard, D. Lim, and K. L. Erickson, “Beef tallow increases the potency of conjugated linoleic acid in the reduction of mouse mammary tumor metastasis,” J Nutr, vol. 136, no. 1, pp. 88–93, Jan. 2006, doi: 10.1093/jn/136.1.88. https://pubmed.ncbi.nlm.nih.gov/16365064/ 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 Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US