Podcasts about Lancet

Neuraxial analgesia (epidural or spinal) combined withtocolytic therapy is the pain control method that best increases the success rate of external cephalic version (ECV), according to the ACOG's PB 221. However, some patients may be reluctant to use regional anesthesia and may askabout IV analgesia. A new study in the AJOG (released as an ePub on March 5, 2026) provides some insights that may be helpful for patient consultation. These investigators compared the success of external cephalic version, modes of delivery, maternal pain, and complications using three strategies: intravenous analgesia with remifentanil, epidural anesthesia, and a stepwise approach in which epidural anesthesia was administered only if intravenous analgesia was unsuccessful. Listen in for details.1.     ACOG PB 2212.     Aiartzaguena, Amaia et al. Comparativeeffectiveness of intravenous remifentanil, epidural anesthesia and a two-stepanalgesic approach for external cephalic version: a large prospectivesingle-center cohort study. American Journal of Obstetrics & Gynecology,Volume 0, Issue 03.     Hao Q, Hu Y, Zhang L, et a l. A SystematicReview and Meta-Analysis of Clinical Trials of Neuraxial, Intravenous, andInhalational Anesthesia for External Cephalic Version. Anesthesia andAnalgesia. 2020. 4.     Wilson MJA, MacArthur C, Hewitt CA, et al.5.     Intravenous Remifentanil Patient-ControlledAnalgesia Versus Intramuscular Pethidine for Pain Relief in Labour (RESPITE):An Open-Label, Multicentre, Randomised Controlled Trial. Lancet. 2018.

‘Then they monetize it…’ What happens when quality brands lovingly crafted are then acquired by private equity and venture capital? How has golf changed in recent decades – and beyond – and how might that related to our broader society? And, might Mitzi have an opportunity to meet John Daly? All this and more on today’s Mondays with Mitzi! edition of Road Warrior Radio. Links Discussed Why Mrs. Meyer’s Clean Day Founder Sold Business, Retired Early – Business Insider John Daly (golfer) – Wikipedia Caddyshack – Wikipedia Let’s talk about Erik van Rooyen’s jogger pants at the 2019 British Open Championship Mac Sinise – Shenandoah – YouTube Oh Shenandoah – Wikipedia What Scottie Scheffler told Lee Trevino as a child which has now come true Grammarly: Free AI Writing Assistance Saint Patrick’s Day – Wikipedia On This Day March 2026 Calendar of Public Holidays | Office Holidays Holidays Today and Upcoming Holidays in the United States What day is it today? Important events every day ad-free | United States On This Day – What Happened on March 16 Today in History: March 16, the My Lai massacre in Vietnam | AP News What Happened on March 16 – On This Day What Happened on March 16 | HISTORY March 16 – Wikipedia What Happened On March 16 In History? 16 | March | 2020 | Executed Today Holidays St. Patrick’s Day (tomorrow, Tue, Mar 17) Historical Events 2016 – President Barack Obama nominated Merrick Garland to take the seat of Supreme Court Justice Antonin Scalia, who had died the previous month. Republicans who controlled the Senate would stick to their pledge to leave the seat empty until after the presidential election; they confirmed Trump nominee Neil Gorsuch in April 2017. 2005 – Actor Robert Blake acquitted: After a three-month-long criminal trial in Los Angeles Superior Court, a jury acquits Robert Blake, star of the 1970s television detective show “Baretta,” of the murder of his 44-year-old wife, Bonny Lee Bakley. 2003 – 23-year-old peace activist Rachel Corrie is crushed to death in Rafah, run over by an Israel Defense Forces bulldozer while trying to obstruct the demolition of a home. 1995 – Mississippi formally ratifies the Thirteenth Amendment to the United States Constitution, becoming the last state to do so. The Thirteenth Amendment was officially ratified in 1865. 1994 – Figure skater Tonya Harding pleaded guilty in Portland, Oregon, to conspiracy to hinder prosecution for covering up an attack on rival Nancy Kerrigan, avoiding jail but drawing a $100,000 fine and three years of probation. 1988 – Iran–Contra affair: Lieutenant Colonel Oliver North and Vice Admiral John Poindexter are indicted on charges of conspiracy to defraud the United States. 1968 – Sen. Robert F. Kennedy of New York announced his candidacy for the Democratic presidential nomination. 1968 – General Motors produces its 100 millionth automobile, an Oldsmobile Toronado 1958 – The Ford Motor Company produced its 50 millionth automobile, the Thunderbird, averaging almost a million cars a year since the company's founding. 1903 – Judge Roy Bean dies: Self-proclaimed “law west of the Pecos,” Roy Bean dies in Langtry, Texas. A saloonkeeper and adventurer, Bean's claim to fame rested on the often humorous and sometimes-bizarre rulings he meted out as a justice of the peace in western Texas during the late 19th century. By then, Bean was in his 50s and had already lived a life full of rough adventures. 1867 – Joseph Lister first outlines the discovery of antiseptic surgery in an article in “The Lancet” 1850 – “The Scarlet Letter” is published: Nathaniel Hawthorne's story of adultery and betrayal in colonial America, The Scarlet Letter, is published. 1802 – President Thomas Jefferson signed a measure authorizing the establishment of the United States Military Academy at West Point, New York. 37 – Caligula became Roman Emperor after the death of his great uncle, Tiberius. Births 1965 – Mark Carney, Canadian economist and politician, Prime Minister of Canada 1959 – Flavor Flav (William Jonathan Drayton Jr.), Hip-hop artist and reality TV star who co-founded the rap group Public Enemy. Made oversize clock necklaces a fashion statement. 1953 – Richard Stallman, American computer scientist and programmer, launched the GNU Project (Sep 1983), founded the Free Software Foundation (FSF) in October 1985, developed the GNU C Compiler and GNU Emacs, and wrote all versions of the GNU General Public License. 1941 – Bernardo Bertolucci, Italian director and screenwriter (died 2018) 1926 – Jerry Lewis, American actor and comedian (died 2017) 1912 – Pat Nixon, First lady who joined her husband on historic trips to China and the Soviet Union and advocated for volunteerism. (died 1993) 1911 – Josef Mengele, German physician, captain and mass-murderer (died 1979) 1751 – James Madison, drafter of the Constitution, recorder of the Constitutional Convention, author of the Federalist Papers and fourth president of the United States, is born on a plantation in Virginia. At just 5‘4”, James Madison was hardly a commanding presence, but that didn’t stop him from shaping American history. Madison first distinguished himself as a student at the College of New Jersey (now Princeton University), where he successfully completed a four-year course of study in two years and, in 1769, helped found the American Whig Society, the second literary and debate society at Princeton (and the world), to rival the previously established Cliosophic Society. (died 1836) Learn more Deaths 1985 – Roger Sessions, American composer, critic, and educator (born 1896) 1975 – T-Bone Walker (Aaron Thibeaux “T-Bone” Walker), American singer-songwriter and guitarist (born 1910) 1971 – Thomas E. Dewey, American lawyer and politician, 47th Governor of New York (born 1902) 1963 – William Beveridge, British economist and Liberal politician who was a progressive, social reformer, and eugenicist who played a central role in designing the British welfare state. (born 1879) 1903 – Roy Bean, self-proclaimed “law west of the Pecos” (born 1825)

Application pour EV0360 : https://hlperformance.caRéférences :Bellisle, F. (2003). Why should we study human food intake behaviour? *Nutrition, Metabolism and Cardiovascular Diseases*, *13*(4), 189–193. [https://doi.org/10.1016/S0939-4753(03)00063-7](https://doi.org/10.1016/S0939-4753(03)00063-7)Canadian Centre on Substance Use and Addiction. (2023). *Canada's guidance on alcohol and health*. CCSA. https://www.ccsa.ca/canadas-guidance-alcohol-and-healthDing, D., Nguyen, B., Nau, T., Luo, M., Del Pozo Cruz, B., Dempsey, P. C., Munn, Z., Jefferis, B. J., Sherrington, C., Calleja, E. A., Hau Chong, K., Davis, R., Francois, M. E., Tiedemann, A., Biddle, S. J. H., Okely, A., Bauman, A., Ekelund, U., Clare, P., & Owen, K. (2025). Daily steps and health outcomes in adults: A systematic review and dose-response meta-analysis. *The Lancet Public Health*, *10*(8), e668–e681. [https://doi.org/10.1016/S2468-2667(25)00164-1](https://doi.org/10.1016/S2468-2667(25)00164-1)Hall, K. D., & Guo, J. (2017). Obesity energetics: Body weight regulation and the effects of diet composition. *Gastroenterology*, *152*(7), 1718–1727. https://doi.org/10.1053/j.gastro.2017.01.052Hall, K. D., Ayuketah, A., Brychta, R., Cai, H., Cassimatis, T., Chen, K. Y., … & Walter, P. J. (2019). Ultra-processed diets cause excess calorie intake and weight gain: An inpatient randomized controlled trial. *Cell Metabolism*, *30*(1), 67–77. https://doi.org/10.1016/j.cmet.2019.05.008Hall, K. D., Sacks, G., Chandramohan, D., Chow, C. C., Wang, Y. C., Gortmaker, S. L., & Swinburn, B. A. (2012). Quantification of the effect of energy imbalance on bodyweight. *The Lancet*, *378*(9793), 826–837. [https://doi.org/10.1016/S0140-6736(11)60812-X](https://doi.org/10.1016/S0140-6736(11)60812-X)Mattes, R. D. (2014). Beverages and positive energy balance: The menace is the medium. *International Journal of Obesity*, *38*(S1), S1–S6. https://doi.org/10.1038/ijo.2014.21National Institutes of Health. (s. d.). *NIH Body Weight Planner* [Outil en ligne]. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/bwpRyan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. *American Psychologist*, *55*(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68Ryan, R. M., & Deci, E. L. (2017). *Self-determination theory: Basic psychological needs in motivation, development, and wellness*. Guilford Press.American College of Sports Medicine. (2022). *ACSM's guidelines for exercise testing and prescription* (11e éd.). Lippincott Williams & Wilkins. *(Position Stand original : 2009)*World Health Organization. (2020). *WHO guidelines on physical activity and sedentary behaviour*. WHO Press. https://www.who.int/publications/i/item/9789240015128

Gavin is joined once again by Richard and Jessamy for a chat about the latest in global health news and the world of Lancet publications, this month covering The Lancet's new Commission, A Citizen-Centred Health System for India, and a new paper in The Lancet Global Health on the effect of global development assistance funding cuts.Click here to access the full content:https://www.thelancet.com/commissions-do/India-Citizen-Healthhttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00008-2/fulltextSend us your feedback!Read all of our content at https://www.thelancet.com/?dgcid=buzzsprout_tlv_podcast_generic_lancetCheck out all the podcasts from The Lancet Group:https://www.thelancet.com/multimedia/podcasts?dgcid=buzzsprout_tlv_podcast_generic_lancetContinue 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

Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting ~37.6 million people globally, with prevalence expected to double in the coming decades.    A recent Lancet Seminar (2026) highlights several key principles shaping modern AF care:   • Stroke prevention with oral anticoagulation remains the cornerstone • Early rhythm control strategies improve cardiovascular outcomes • Catheter ablation is increasingly used as first-line therapy • Lifestyle modification—weight loss, exercise, alcohol reduction—reduces AF burden • Integrated care models such as the ABC pathway and AF-CARE improve outcomes   The future of AF management is holistic, preventive, and patient-centred.   #Cardiology #AtrialFibrillation #StrokePrevention #Electrophysiology #PrecisionMedicine

The Operation of the Century - Why Total Hip Replacement Keeps Getting Better Interview with Adolph V. Lombardi, Jr., MD, FACS who has performed 38,000+ joint replacements. Topics discussed: Why total hip replacement is considered the “operation of the century” (as described in The Lancet); Modern hips use cementless fixation, advanced ceramics, and highly cross-linked polyethylene, dramatically improving durability to 25–30+ years (or more); Complications like infection, fracture, and dislocation are rare (~1%) and aggressively addressed through patient optimization and surgical advances. Timing now depends on symptoms and quality of life, not just X-rays or age. Emerging innovations, including AI-guided robotics and a promising “reverse hip” design, aim to further improve stability and outcomes. Link to sign up to learn more or enter the ongoing Clinical Trial for this new Technology (https://hipinnovationtechnology.com/) To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Resistant hypertension remains one of the most stubborn challenges in cardiovascular medicine.   The Bax24 phase 3 trial, published in The Lancet (2026), evaluated baxdrostat, a selective aldosterone synthase inhibitor, in patients already receiving multiple antihypertensive agents.   Key findings: • −16.6 mmHg reduction in 24-hour ambulatory SBP • −14.0 mmHg placebo-corrected difference (p

Tom interviews British doctor Clare Craig about her new book (including a newly released audiobook) and her involvement in a European Court of Human Rights case. Craig describes being smeared and censored during COVID, alleging UK information operations involving the 77th Brigade and a Counter Disinformation Unit, and cites claims of UN/UNICEF-funded influencer campaigns and problematic WHO priorities. She argues COVID policies (lockdowns, masking, distancing) and vaccines failed to stop infection, severe disease, or death, critiques scientific publishing and peer review, and recounts a dispute with The Lancet over a myocarditis paper she says misused data. Craig discusses ethical drift toward utilitarian public health, revisits historical narratives on smallpox vaccination and the 1918 “Spanish flu” (including a possible aspirin-toxicity role), and outlines the Finnish “Mika” case over vaccine restrictions.00:00 Meet Clare Craig09:26 Losing Trust In Institutions18:42 Ethics Nuremberg To Helsinki24:51 Smallpox Vaccine Origins29:10 Crude Early Vaccines29:58 Pushback and Belief30:49 Smallpox Vaccine Reality31:59 Monkeypox Emergency Politics33:57 Spanish Flu Numbers36:02 Two Pathologies Explained38:12 Aspirin Toxicity Theory42:24 Covid Wave Math45:00 Aerosols Everywhere48:05 Household Data and Vaccines52:18 Where Did Flu Go54:03 Dashboards and Modeled Data56:20 Human Rights Case Closinghttps://x.com/ClareCraigPathSpiked: A shot in the dark: https://a.co/d/4W8P2JD========Slides, summaries, references, and transcripts of my podcasts: https://tomn.substack.com/p/podcast-summariesMy Linktree: https://linktr.ee/tomanelson1

Text us a comment or question!What if up to 40% of dementia cases could be prevented — not with drugs, but with daily lifestyle choices?In this powerful episode of The Over 50 Health & Wellness Show, I sit down with molecular biologist and AI health innovator Thoryn Stephens, Founder & CEO of BRAIN.ONE, to unpack the real science behind brain health, longevity, and sustainable optimization after 50.We go beyond hype and dig into what actually moves the needle when it comes to protecting your cognition, extending your health span, and building a strong, capable body and mind for decades to come.In This Episode, We Cover:1. The Lifestyle Levers That Could Prevent 30–40% of DementiaBased on emerging global research, including insights from The Lancet 2024, we discuss:Why nutrition is foundational for brain healthThe role of strength training and physical activityHow sleep impacts cognitive declineWhy stress and social isolation matter more than you thinkThe surprising impact of hearing and vision health2. The #1 Longevity Hack (Hint: It's Not a Supplement)If you're looking for the single most powerful lever for brain health, Thoryn says it's this: Sleep.We discuss:Why sleep deprivation accelerates agingHow alcohol affects heart rate variability (HRV) and recoveryWhy measuring your sleep can change your behaviorHow to optimize without becoming obsessive 3. Measure What Matters: Wearables & Health Tracking After 50“You can't manage what you don't measure.”We break down:How wearables like Garmin, Oura, and Apple Watch can guide behaviorWhat HRV actually tells youHow small data insights lead to big long-term changesThe danger of letting data run your life 4. Peptides, GLP-1s & The Wild West of Longevity MedicinePeptides are everywhere right now. But are they miracle solutions — or risky trends?We cover:What peptides actually areThe difference between research and prescription peptidesMicrodosing GLP-1s and what it meansThe regulatory gray zoneWhy most doctors aren't trained in this space 5. AI, Brain Optimization & The Future of HealthWe explore:How AI is being used in brain-computer interfacesThe potential (and risks) of uploading health data to AI platformsWhat “Mindspan” means — and why it mattersWhy the future of health is hyper-personalizedBut here's the twist…Despite all the high-tech innovation, Thoryn keeps coming back to the basics. 

Send a textRewind to 5 – 11 March 2006 and the world is juggling human rights debates, dancehall domination and the Pope casually flexing a 2GB iPod Nano.

The landscape of weight loss medications is evolving rapidly. Just this week, Health Canada approved an expanded indication for Ozempic, semaglutide injection, to reduce the risk of major adverse cardiovascular events in adults with type two diabetes who have established cardiovascular disease or chronic kidney disease. This approval comes based on positive outcomes from multiple clinical trials including SUSTAIN 6, PIONEER 6, FLOW and SOUL, marking an important advancement in how these medications are being used beyond their original diabetes treatment purpose.Meanwhile, the competition in the GLP one drug space is intensifying. A major trial published in The Lancet reveals that a new medication called orforglipron outperformed oral semaglutide tablets in managing both blood sugar levels and weight loss. Among nearly seventeen hundred trial participants, people taking orforglipron experienced six to eight percent average weight loss compared to four to five percent for those on semaglutide tablets. Orforglipron also doesn't require being taken on an empty stomach, offering greater convenience. However, more people discontinued orforglipron due to gastrointestinal issues, with discontinuation rates of nine to ten percent compared to four to five percent for semaglutide.The adoption of these medications continues to surge. According to a survey by Leger Healthcare released this week, approximately three million Canadian adults are currently taking GLP one drugs such as Ozempic or Mounjaro. More than half of those surveyed reported decreased appetite and forty percent said they experienced fewer food cravings. These effects are reshaping consumer behavior, with thirty percent of users going to restaurants or getting takeout less often, thirty five percent ordering smaller portions, and about a third purchasing more fresh fruits and vegetables and protein rich foods.The economic impact is substantial. J.P. Morgan Global Research forecasts that the global incretin market, which includes GLP ones, will reach two hundred billion dollars by twenty thirty. The firm estimates approximately twenty five million Americans will be on GLP one treatment by twenty thirty, up significantly from ten million in twenty twenty five.Access continues expanding as oral formulations gain approval and pricing becomes more competitive. The Trump administration announced the BALANCE pilot program, which seeks to provide Medicare recipients GLP one coverage with a fifty dollar monthly cap on out of pocket spending. This expansion addresses a significant barrier, as about two million Canadian adults would like to take these medications but currently cannot due to cost and insurance coverage limitations.Thanks for tuning in. Please come back next week for more. Thanks for listening, please subscribe, and remember this episode was brought to you by Quiet Please podcast networks. For more content like this, please go to Quiet Please dot Ai.Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI

Welcome to Ozempic Weightloss Unlocked, where we dive into the latest news on Ozempic, from medical breakthroughs to lifestyle impacts.Johns Hopkins Bloomberg School of Public Health researchers analyzed 64 clinical trials with tens of thousands of patients on GLP-1 drugs like semaglutide, the key ingredient in Ozempic. They found these drugs work similarly across ages, races, ethnicities, starting weights, and blood sugar levels. Women saw about 11 percent average weight loss from their starting weight, while men averaged 7 percent, a meaningful difference possibly linked to estrogen interactions. Senior author Hemal Mehta says this builds confidence for doctors and patients in diverse groups. The study appeared in JAMA Internal Medicine on March 2.In exciting pill news, ScienceAlert reports a phase 3 trial where Eli Lillys orforglipron outperformed oral semaglutide. Among 1,698 people with type 2 diabetes, orforglipron delivered 6 to 8 percent weight loss and better blood sugar control versus 4 to 5 percent on semaglutide tablets. It does not need an empty stomach, boosting convenience, though more dropped out due to stomach issues. Published in The Lancet, this positions orforglipron as a strong oral contender, with heart health trials underway.J.P. Morgan Global Research forecasts the GLP-1 market hitting 200 billion dollars by 2030, with 25 million Americans on these treatments, up from 10 million in 2025. Oral versions approved late 2025 are driving growth by skipping injections. Medicare and Medicaid expansions, like the BALANCE program capping out-of-pocket at 50 dollars monthly, plus falling prices and generics abroad, mean broader access. This could reshape food spending, cutting grocery bills as calorie intake drops.Patient satisfaction with semaglutide remains high, Rheumatology Advisor notes, fueled by strong weight loss outweighing gut side effects.These updates show Ozempic and kin transforming health, but talk to your doctor for personal fit.Thanks for tuning in, listeners. Subscribe for more insights. This has been a quiet please production, for more check out quiet please dot ai. Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI

When the ice cracked beneath Darven Miller's feet on December 13, 1979, it triggered a cascade of events that seemed impossible to survive. The 11-year-old remained trapped under the frozen surface of Duncan Creek for nearly 30 minutes, his body temperature plummeting to 82 degrees. By the time rescuers pulled him from the water, he had no pulse, no breathing, and pupils fixed and dilated—clinically dead by every measure. What the medical team at a small Wisconsin hospital did next, and what happened 70 minutes into their desperate resuscitation attempt, would challenge everything doctors thought they knew about the limits of human survival. This is a story about the microscopic margin between death and life, and about a boy who became a man determined to live every moment to the fullest. 00:00 Welcome to Crux 00:31 Ice Breaks Open 02:09 Setting the Scene 03:26 Under the Ice 04:19 Rescue at 30 Minutes 06:10 ER Fight Begins 06:54 Acidosis Explained 08:07 Rewarming and Defib 10:50 Heartbeat Returns 11:43 Wakes Up Asking Water 13:15 Rehab and Full Recovery 14:57 Why He Survived 17:40 Life After the Miracle 19:01 Lessons for Medicine 25:34 Final Takeaways 27:26 Listener Wrap Up Listen AD FREE: Support our podcast at patreaon: http://patreon.com/TheCruxTrueSurvivalPodcast Email us! thecruxsurvival@gmail.com Instagram https://www.instagram.com/thecruxpodcast/ Get schooled by Julie in outdoor wilderness medicine! https://www.headwatersfieldmedicine.com/ REFERENCES: 1. "45 years pass since boy survived cold water drowning," WEAU, March 23, 2024 2. "Boy who almost drowned as good as new," UPI Archives, December 15, 1980 3. "Recovery of a 62-year-old Man From Prolonged Cold Water Submersion," ScienceDirect, November 4, 2005 4. "Hypothermia. Cold-water drowning," PubMed, PMID: 2054134 5. "Survival after prolonged submersion in cold water without neurologic sequelae," PubMed, PMID: 7387271 6. "Ice Water Drowning Survival After 147-Minute Submersion and 7°C Hypothermic Circulatory Arrest," JACC: Case Reports, 2025 7. "How to bring cold water drowning victims back to life," MyPoolSigns Blog, March 11, 2025 8. "Cold water immersion: sudden death and prolonged survival," The Lancet, December 1, 2003 9. "Anna Bågenholm," Wikipedia, November 6, 2025 10.     "Successful resuscitation after drowning with severe hypernatraemia," PMC, December 2019 11.     "Hypothermia – Core EM," coreem.net 12.     "Duncan Creek Trail," GO Chippewa County Wisconsin 13.     "HSHS St. Joseph's Hospital," Hospital Sisters Health System website 14.     "St. Joseph's Hospital memorialized in exhibit at History Center in Chippewa Falls," Chippewa Herald-Telegram, November 29, 2024 15.     "Our History at HSHS Medical Group," HSHS website Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Welcome to Episode 6 of our monthly GU Cast Journal Club! Two important papers in upper tract urothelial cancer (the POUT trial of adjuvant chemo post nephro-ureterectomy), and metastatic testicular cancer (the SEMS trial of surgery for early metastatic seminoma). We are delighted to welcome back our GU Cast Journal Club Editors, Dr Carlos Delgado (Melbourne, AUS), and Dr Elena Berg (Munich, GER), along with main GU Cast Hosts, Renu Eapen and Declan Murphy. No prostate cancer today, and go easy on Declan he is struggling with man flu!Links to papers below:1. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial Lancet 20202. Surgery in Early Metastatic Seminoma: A Phase II Trial of Retroperitoneal Lymph Node Dissection for Testicular Seminoma With Limited Retroperitoneal Lymphadenopathy J Clin Oncol 2023GU Cast Journal Club is supported by our Partner, MSD, through an unrestricted educational grant.Even better on our YouTube channelAbout GU Cast Journal Club:Each month, two papers are discussed, each of which are of importance to the GU Oncology community. These may be recent papers, or occasionally we will chose a classic landmark paper in GU Oncology. The objective is to draw attention to important papers in GU Oncology, and critique these in a robust manner. The key target audience is trainees working in Urology, Medical Oncology, Radiation Oncology, Nuclear Medicine, and diagnostic specialties such as Radiology and Pathology. But any of our regular audience are likely to enjoy this Journal Club series.

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&

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?

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/. 

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.

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.

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.

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

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