Podcasts about medicine baltimore

Anemia can negatively affect quality of life and treatment outcomes for patients with high-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia. In this episode, CANCER BUZZ speaks with Amy DeZern, MD, MHS, director, Bone Marrow Failure and MDS Program, Johns Hopkins University School of Medicine in Baltimore, Maryland, Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, clinical oncology pharmacy manager, Atrium Health Levine Cancer in Charlotte, North Carolina, and David Sallman, MD, assistant member, Department of Malignant Hematology, Moffitt Cancer Center in Tampa, Florida. Their discussion elucidates an array of patient-centered approaches, touches on social determinants of health, and highlights collaborative measures to support care coordination in the management of anemia in patients with high-risk myelodysplastic syndrome and acute myeloid leukemia.   “It really does take a village to manage the anemia of high-risk MDS…We as providers need to think through transfusion mitigation strategies but also keep our patients safe.” –Amy DeZern, MD, MHS   “Health disparities can play a really important role in affecting outcomes. And a lot of that is multifactorial—it may be due to patients without insurance having a higher tendency to delay seeking care due to the associated cost of seeking medical attention, and therefore they may present sicker.”—Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP “There's no question, especially as therapies are getting more complex, and the side effects as far as the severity of cytopenias are increasing, this collaboration between blood bank centers and community oncologists is going to be increasingly important.”—David Sallman, MD Amy DeZern, MD, MHS Director, Bone Marrow Failure and MDS Program Professor of Oncology and Medicine Johns Hopkins University School of Medicine Baltimore, MD   Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP Clinical Oncology Pharmacy Manager Atrium Health Levine Cancer Charlotte, NC   David Sallman, MD Assistant Member, Department of Malignant Hematology Moffitt Cancer Center Tampa, Florida   This episode was developed in connection with an initiative of the ACCC education program Myelodyplastic Syndromes, Optimal Management of Anemia in Adults with High-Risk MDS, which is supported by Gilead.   Resources: Myelodysplastic Syndromes - ACCC Achieving & Maintaining Better Outcomes for Patients with Acute Myeloid Leukemia Project - ACCC Disparities in Acute Myeloid Leukemia - ACCC  

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021. Originally released: February 13, 2019 In the second half of our two-part series on complications of organ transplantation, Dr. Raj Dhar (Neurocritical Care, Washington University in St. Louis) discusses his experience managing the noninfectious complications of organ transplantation--from drug toxicities to multidisciplinary medical care. Produced by James E Siegler and Raj Dhar. Music by Steve Combs, Lee Rosevere, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast. REFERENCES Dhar R, Young GB, Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocrit Care 2008;8(2):253-8. PMID 17928960Dhar R. Neurologic complications of transplantation. Handb Clin Neurol 2017;141:545-572. PMID 28190435Mateen FJ, Dierkhising RA, Rabinstein AA, Van De Beek D, Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant 2010;10(4):908-14. PMID 20121751Muñoz P, Valerio M, Palomo J, et al. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore) 2010;89(3):166-75. PMID 20453603Senzolo M, Ferronato C, Burra P. Neurologic complications after solid organ transplantation. Transpl Int 2009;22(3):269-78. PMID 19076332Wu Q, Marescaux C, Wolff V, et al. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol 2010;64(3):169-77. PMID 20699617 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Hereditary breast cancer is a significant concern, with BRCA1 and BRCA2 mutations accounting for many inherited breast cancer cases. However, a 2018 survey by ACCC revealed the underutilization of BRCA testing, showcasing a significant gap in care. In this podcast, Joy Larsen Haidle, Genetic Counselor at North Memorial Health Cancer Center in Robbinsdale, Minnesota, and Lillie Shockney, University Distinguished Service Professor of Breast Cancer, Professor of Surgery at Johns Hopkins University School of Medicine in Baltimore, Maryland, delve into the topic of BRCA mutation testing within breast cancer care, highlighting care gaps and opportunities for improvement that were identified in the 2023 ACCC BRCA Testing Reassessment Survey.      “There are treatments that are specific for women who carry a BRCA1 or BRCA2 gene that have metastatic disease. So, by not testing them, they are not receiving the benefit of specific drugs that have been developed, that only work, for BRCA1 and BRCA2 gene mutation carriers who have advanced disease.” Lillie Shockney, RN, BS, MAS, HON- ONN-CG     “In the past 4 years in particular, the ability for patients to reach out and see a genetic counselor via telehealth has rapidly improved access for providers across the country.” Joy Larsen Haidle, MS, LCGC   Joy Larsen Haidle, MS, LCGC Genetic Counselor North Memorial Health Cancer Center Robbinsdale, MN    Lillie D Shockney, RN., BS., MAS, HON- ONN-CG University Distinguished Service Professor of Breast Cancer, Professor of Surgery Johns Hopkins University School of Medicine Baltimore, MD   Resources:   2021 ACCC Presentation on Genetic Counseling Rates at ASCO ACCC 2018 Survey Summary Report

Alex and Venk talk through a previous case where they care for a young person with meningococcemia on a night shift. We review the disease, what to watch for, how to treat it, and go over some of the residue after being part of a case like this. We also review some of the considerations regarding ECMO for severe sepsis.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Heckenberg SG, et al. Clinical features, outcome and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore) 2008. 87(4):185 Brechot N, Hajage D, et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. Lancet 2020. 396(10250)545-552 Ling RR, Ramanathan K, et al. Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis. Crit Care 2021. Jul 14;25(1):246   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs

Dr. Tyler Cymet, D.O is an internal medicine physician in Baltimore Maryland who has had an amazing and diverse career both in clinical practice and organized medicine. We were excited when Dr. Cymet reached out to us to be a guest on our podcast!  Dr. Cymet did his undergraduate studies at Emory University and continued his medical education at NOVA Southeastern University. He  pursued a Research fellowship at Chicago college of osteopathic medicine and completed an internal medicine residency at Yale university.  He continued his journey in Academics at Mount Sinai/John Hopkins for 18 years. Dr Cymet worked for AACOM (the American Association of Colleges of Osteopathic Medicine) for 14 years to improve education  and curriculum for Osteopathic medical schools. While at AACOM Dr Cymet  started a program called NAOME which helped to advance and develop D.O leaders and educators. Dr. Cymet is currently focusing his efforts on developing a college of osteopathic medicine in Maryland for underserved minorities. He is helping other DO “legends” such as Dr. Barbara Ross-Lee to create an osteopathic school to train diverse physicians and to help promote population health.We hope you enjoy this episode. 

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 111ème épisode, Sébastien, Nicolas et Isabelle terminent leur série sur le processus de décision partagée, cette fois en discutant des avantages, des obstacles et des moyens de l'appliquer au quotidien à l'aide d'outils. Les objectifs pour les épisodes 110 et 111 sont les suivants: Définir le processus de prise de décision partagée Identifier les bénéfices et les inconvénients du processus de décision partagée Appliquer un processus de décision partagée Ressources pertinentes en lien avec l'épisode Stacey D et coll. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431. Coronado-Vázquez V et coll. Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care: A systematic review. Medicine (Baltimore). 2020;99:e21389. Outils d'aide à la décision partagéeMcCormack J, Pfiffner P. The absolute CVD Risk / Benefit Calculator. 2017. PEER. Comparing Treatment Options for Pain: The C-TOP Tool. Mayo Foundation for Medical Education and Research. Bone Health Choice Decision Aid. 2023. BMJ Publishing Group. BMJ Rapid Recommendations. 2023. The Ottawa Hospital Research Institute. Patient Decision Aids. 2022. Primary Health Tasmania. Medication Management - deprescribing. 2023.

Un nouvel épisode du Pharmascope est maintenant disponible! Dans de ce 110ème épisode, Sébastien, Nicolas et Isabelle discutent d'un concept souvent mentionné mais pas toujours appliqué: le processus de décision partagée. Les objectifs pour les épisodes 110 et 111 sont les suivants: Définir le processus de prise de décision partagée Identifier les bénéfices et les inconvénients du processus de décision partagée Appliquer un processus de décision partagée Ressources pertinentes en lien avec l'épisode The SHARE Approach—Essential Steps of Shared Decisionmaking: Expanded Reference Guide with Sample Conversation Starters. Septembre 2020. Agency for Healthcare Research and Quality, Rockville, MD. Institut national d'excellence en santé et en services sociaux. La prise de décision partagée: une approche gagnante. Octobre 2019. Hoffmann TC, Del Mar C. Clinicians' Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review. JAMA Intern Med. 2017;177:407-19. Trewby PN et coll. Are preventive drugs preventive enough? A study of patients' expectation of benefit from preventive drugs. Clin Med (Lond). 2002;2:527-33. Douglas F et coll. Differing perceptions of intervention thresholds for fracture risk: a survey of patients and doctors. Osteoporos Int. 2012;23:2135-40. Zipkin DA et coll. Evidence-based risk communication: a systematic review. Ann Intern Med. 2014;161:270-80. Stacey D et coll. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431. Coronado-Vázquez V et coll. Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care: A systematic review. Medicine (Baltimore). 2020;99:e21389.

Dr. Chris Di Capua and Dr. Bryan Glezerson (@BryanGlezerson) join the show to discuss the literature around the risk of aspiration with LMAs compared to ETTs. This is an episode produced from the Depth of Anesthesia Podcast Elective that's available to MGH anesthesia residents. Special thanks to Dr. Saddawi-Konefka for supporting the initiative. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Keller C, Sparr HJ, Luger TJ, Brimacombe J. Patient outcomes with positive pressure versus spontaneous ventilation in non-paralysed adults with the laryngeal mask. Can J Anaesth. 1998 Jun;45(6):564-7. doi: 10.1007/BF03012709. PMID: 9669012. Bernardini A, Natalini G. Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation. Anaesthesia. 2009 Dec;64(12):1289-94. doi: 10.1111/j.1365-2044.2009.06140.x. Epub 2009 Oct 23. PMID: 19860753. Qamarul Hoda M, Samad K, Ullah H. ProSeal versus Classic laryngeal mask airway (LMA) for positive pressure ventilation in adults undergoing elective surgery. Cochrane Database Syst Rev. 2017;7(7):CD009026. Published 2017 Jul 20. doi:10.1002/14651858.CD009026.pub2 Maltby JR, Beriault MT, Watson NC, Fick GH. Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-Classic vs. tracheal intubation. Can J Anaesth. 2000 Jul;47(7):622-6. doi: 10.1007/BF03018993. PMID: 10930200. Kim D, Park S, Kim JM, Choi GS, Kim GS. Second generation laryngeal mask airway during laparoscopic living liver donor hepatectomy: a randomized controlled trial. Nature. 2021 Feb 11;11(1):3532. doi: 10.1038/s41598-021-83173-5. PMID: 33574495; PMCID: PMC7878811. Parikh SS, Parekh SB, Doshi C, Vyas V. ProSeal Laryngeal Mask Airway versus Cuffed Endotracheal Tube for Laparoscopic Surgical Procedures under General Anesthesia: A Random Comparative Study. Anesth Essays Res. 2017;11(4):958-963. doi:10.4103/aer.AER_97_17 Park SK, Ko G, Choi GJ, Ahn EJ, Kang H. Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2016 Aug;95(33):e4598. doi: 10.1097/MD.0000000000004598. PMID: 27537593; PMCID: PMC5370819. White LD, Thang C, Hodsdon A, Melhuish TM, Barron FA, Godsall MG, Vlok R. Comparison of Supraglottic Airway Devices With Endotracheal Intubation in Low-Risk Patients for Cesarean Delivery: Systematic Review and Meta-analysis. Anesth Analg. 2020 Oct;131(4):1092-1101. doi: 10.1213/ANE.0000000000004618. PMID: 32925330. Halaseh BK, Sukkar ZF, Hassan LH, Sia AT, Bushnaq WA, Adarbeh H. The use of ProSeal laryngeal mask airway in caesarean section--experience in 3000 cases. Anaesth Intensive Care. 2010 Nov;38(6):1023-8. doi: 10.1177/0310057X1003800610. PMID: 21226432. Nicholson A, Cook TM, Smith AF, Lewis SR, Reed SS. Supraglottic airway devices versus tracheal intubation for airway management during general anaesthesia in obese patients. Cochrane Database Syst Rev. 2013 Sep 9;(9):CD010105. doi: 10.1002/14651858.CD010105.pub2. PMID: 24014230.

In this week's episode of the Spine & Nerve podcast, Drs. Julie Hastings, Nicolas Karvelas, and Brian Joves present a journal club on interventional management of patients with persistent pelvic pain syndrome. Three different interventions are covered in the articles presented, showing a range on invasiveness and diversity of targets to help moderate the pain symptoms. Listen as the doctors dive in and discuss these articles and discuss ways these articles might help patients living with persistent pelvic pain syndrome and the physicians caring for them. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Hong DG, Hwang SM, Park JM. Efficacy of ganglion impar block on vulvodynia: Case series and results of mid- and long-term follow-up. Medicine (Baltimore). 2021;100(30):e26799. 2. Agarwal-Kozlowski K, Lorke DE, Habermann CR, Am Esch JS, Beck H. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009 Sep;25(7):570-6. 3. Istek A, Gungor Ugurlucan F, Yasa C, Gokyildiz S, Yalcin O. Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Arch Gynecol Obstet 2014;290(2):291–8 4. Hunter CW, Yang A. Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration. Neuromodulation. 2019 Jan;22(1):87-95. doi: 10.1111/ner.12801. Epub 2018 Aug 1. PMID: 30067887.

Classic texts say that tai chi will help you become “Strong as an oak, flexible as a willow, and [mentally] clear as still water.”It's often called meditation in motion. Scientific studies are showing more and more health benefits that you can get from this practice. Dianne Bailey, CSCS, FAS, CTCIAs a fitness professional, martial artist, and owner of a successful personal training studio in Denver, Dianne is passionate about creating the best opportunities for the mature adult to enjoy health and fitness. This passion has led her to create a system for learning Tai Chi which will empower fitness professionals to be able to offer this amazing form of exercise to their clientele and help others learn this wonderful form of “movement meditation.”  Dianne is the author of three books: Eating Simply  Open the Door to Tai Chi . . . Tai Chi for the Everyday PersonHealthy, Happy and Fit – Ageless Exercise to enjoy Your Best Years YetDianne is a CSCS, a Functional Aging Specialist and a Certified Tai Chi Instructor. She has presented the benefits of Tai Chi at the Functional Aging Summit, ICAA Conference and Fitness Fest. In her engaging, easy-going yet commanding style, she hopes to encourage people to include Tai Chi in their offerings.Here are some Tai Chi resources.New 30 Days of Tai Chi.  Here is the link to Day 1.A link to Diane's presentation, 'Who can use Tai Chi'  Tai Chi for Balance - VeDA (vestibular.org)Articles: (So many choices)Wang LC, Ye MZ, Xiong J, Wang XQ, Wu JW, Zheng GH. Optimal exercise parameters of tai chi for balance performance in older adults: A meta-analysis. J Am Geriatr Soc. 2021 Jul;69(7):2000-2010. doi: 10.1111/jgs.17094. Epub 2021 Mar 26. PMID: 33769556.Hu C, Qin X, Jiang M, Tan M, Liu S, Lu Y, Lin C, Ye R. Effects of Tai Chi Exercise on Balance Function in Stroke Patients: An Overview of Systematic Review. Neural Plast. 2022 Mar 9;2022:3895514. doi: 10.1155/2022/3895514. PMID: 35309256; PMCID: PMC8926482.Zhang T, Lv Z, Gao S. Tai Chi Training as a Primary Daily Care Plan for Better Balance Ability in People With Parkinson's Disease: An Opinion and Positioning Article. Front Neurol. 2021 Dec 24;12:812342. doi: 10.3389/fneur.2021.812342. PMID: 35002945; PMCID: PMC8739955.Li G, Huang P, Cui SS, et al. Mechanisms of motor symptom improvement by long-term Tai Chi training in Parkinson's disease patients. Transl Neurodegener. 2022;11(1):6. Published 2022 Feb 7. doi:10.1186/s40035-022-00280-7Guo G, Wu B, Xie S, et al. Effectiveness and safety of Tai Chi for chronic pain of knee osteoarthritis: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2022;101(2):e28497. doi:10.1097/MD.0000000000028497Winser SJ, Tsang WW, Krishnamurthy K, Kannan P. Does Tai Chi improve balance and reduce falls incidence in neurological disorders? a systematic review and meta-analysis. Clin Rehabil. (2018) 32:1157–68. 10.1177Zou L, Han J, Li C, Yeung AS, Hui SS-C, Tsang WWN, et al. . Effects of tai chi on lower limb proprioception in adults aged over 55: a systematic review and meta-analysis. Arch Phys Med Rehabil. (2019) 100:1102–13. 10.1016/j.apmr.2018.07.425 

Recording of the Evidence Based Hair Podcast for the April 25, 2022 issue.   STUDIES REFERENCED   ALLERGIC CONTACT DERMATITIS STUDIES Feryel A et al (starts at 3:51). Unusual clinical presentation of allergic contact dermatitis to topical minoxidil. Contact Dermatitis. 2022 Mar 28 Pham et al (starts at 12:18). Allergic Contact Dermatitis of the Scalp Associated With Scalp Applied Products: A Systematic Review of Topical Allergens. Dermatitis. 2022 Mar 22.   PULSED DYE LASER AND HAIR LOSS IN INFANTILE HEMANGIOMAS Yang et al (starts at 19:56). Risk factors of long-term alopecia after pulsed-dye laser treatment for infantile scalp hemangiomas: A retrospective study. J Dermatol. 2022 Apr 5. Feldstein S et al. Can long-term alopecia occur after appropriate pulsed-dye laser therapy in hair-bearing sites? Pediatric dermatologists weigh in. Dermatol Surg. 2015 Mar;41(3):348-51.   ORAL PIGMENTATION FROM HYDROXYCHLOROQUINE Silva PUJ et al (starts at 31:26). Oral pigmentation as an adverse effect of chloroquine and hydroxychloroquine use: A scoping review. Medicine (Baltimore). 2022 Mar 18;101(11):e29044.   PERMANENT CHEMOTHERAPY INDUCED ALOPECIA Lyakhovitsky A et al (starts at 37:38). Permanent chemotherapy-induced alopecia after hematopoietic stem cell transplantation treated with low-dose oral minoxidil. JAAD Case Rep. 2022 Feb 17;22:64-67. Vano-Galvan S et al. Safety of low dose oral minoxidil for hair loss: A multicenter study of 1404 patients. JAAD 2021; 84: 1644-51. Sanabria B et al. Adverse effects of low dose oral minoxidil for androgenetic alopecia in 435 patients. JAAD 2021; 84: 1175-78. Kolla et al (starts at 54:24). Permanent chemotherapy-induced alopecia presenting with erosive pustular dermatosis-like retention hyperkeratosis. JAAD Case Rep. 2022 Jan 6;21:77-79. Yin et al (starts at 58:25). Dermatologist Awareness of Scalp Cooling for Chemotherapy-induced Alopecia. J Am Acad Dermatol. 2022 Mar 9;S0190-9622(22)00386-3  

This is a special episode brought to you in association with Hepatology Knowledge into Practice. People with type 2 diabetes or obesity are at higher risk of developing non-alcoholic fatty liver disease (NAFLD) including non-alcoholic steatohepatitis (NASH). Some estimates report a prevalence of NAFLD of 60% in people with type 2 diabetes, rising to 78% in those who also have obesity. So what's behind this link? In this podcast episode, Professor Giulio Marchesini explores the relationships between NAFLD, type 2 diabetes and obesity and offers advice for healthcare professionals caring for people with one or more of these conditions. By completing this activity you can qualify for 0.25 CME credits. To claim your credits, you must listen to the podcast and successfully pass the post-module assessment at diabetes.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: Dai W, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis. Medicine (Baltimore). 2017 Sep;96(39):e8179. Padda J, et al. Non-Alcoholic Fatty Liver Disease and Its Association With Diabetes Mellitus. Cureus. 2021 Aug 20;13(8):e17321. Mantovani A, et al. Nonalcoholic Fatty Liver Disease and Risk of Incident Type 2 Diabetes: A Meta-analysis. Diabetes Care. 2018 Feb; 41(2):372-382. Targher G, et al. Diabetologia. 2008 Mar; 51(3):444-50. Godoy-Matos AF, et al. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020 Jul 14;12:60. Eslam M, Sanyal AJ, George J; International Consensus Panel. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020 May;158(7):1999-2014.e1. Kim D, et al. Body Fat Distribution and Risk of Incident and Regressed Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol. 2016 Jan;14(1):132-8.e4. Disclosures: Prof. Giulio Marchesini declares the following: Advisory Board: Novartis, Eli Lilly, Gilead, MSD, Pfzier, Astra-Zeneca Liberum IME staff, ACHL staff and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose. The Academy for Continued Healthcare Learning (ACHL) requires that the faculty participating in an accredited continuing education activity disclose all affiliations or other financial relationships (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. All conflicts of interest have been mitigated prior to this activity. Funding: This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.

Christian and Mike discuss the ins and outs of Plagiocephaly from the perspective of the Paediatric Chiropractor. For those of you playing at home, here are the references mentioned in today's episode: Kim DG, Lee JS, Lee JW, et al. The Effects of Helmet Therapy Relative to the Size of the Anterior Fontanelle in Nonsynostotic Plagiocephaly: A Retrospective Study. J Clin Med. 2019;8(11):1977 Burmeister S, Kayne A, Yazdanyar A, Hagstrom J, Burmeister D. Plagiocephaly Perception and Prevention: A Need to Intervene Early to Educate Parents. Open J Occup Ther. 2021;9(3):1-11 Collett BR, Wallace ER, Ola C, Kartin D, Cunningham ML, Speltz ML. Do Infant Motor Skills Mediate the Association Between Positional Plagiocephaly/Brachycephaly and Cognition in School-Aged Children? Phys Ther. 2021;101(2) Pastor-Pons I, Hidalgo-García C, Lucha-López MO, et al. Effectiveness of pediatric integrative manual therapy in cervical movement limitation in infants with positional plagiocephaly: a randomized controlled trial. Ital J Pediatr 2021 471. 2021;47(1):1-12 Turk AE, McCarthy JG, Thorne CH, Wisoff JH. The “back to sleep campaign” and deformational plagiocephaly: is there cause for concern? J Craniofac Surg. 1996;7(1):12-18 Argenta L. Clinical Classification of Positional Plagiocephaly. J Craniofac Surg. 2004;15(3):368-372 van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, L'Hoir MP, Helders PJM, Engelbert RHH. Risk Factors for Deformational Plagiocephaly at Birth and at 7 Weeks of Age: A Prospective Cohort Study. Pediatrics. 2007;119(2):e408-e418 Branch LG, Kesty K, Krebs E, Wright L, Leger S, David LR. Argenta clinical classification of deformational plagiocephaly. J Craniofac Surg. 2015;26(3):606-610. Murgia M, Venditto T, Paoloni M, et al. Assessing the cervical range of motion in infants with positional plagiocephaly. J Craniofac Surg. 2016;27(4):1060-1064. McLain RF. Mechanoreceptor endings in human cervical facet joints. Iowa Orthop J. 1993;13:149-154 Sergueef N, Nelson KE, Glonek T. Palpatory diagnosis of plagiocephaly. Complement Ther Clin Pract. 2006;12(2):101-110 Kim DH, Kwon DR. Neurodevelopmental delay according to severity of deformational plagiocephaly in children. Medicine (Baltimore). 2020;99(28):e21194 Hussein MA, Woo T, Yun IS, Park H, Kim YO. Analysis of the correlation between deformational plagiocephaly and neurodevelopmental delay. J Plast Reconstr Aesthetic Surg. 2018;71(1):112-117 Unwin S, Dika C. Deformational Plagiocephaly—A Focus on Prevention. J Nurse Pract. 2017;13(2):162-169 Collett BR, Gray KE, Starr JR, Heike CL, Cunningham ML, Speltz ML. Development at age 36 months in children with deformational plagiocephaly. Pediatrics. 2013;131(1) Shamji MF, Fric-Shamji EC, Merchant P, Vassilyadi M. Cosmetic and cognitive outcomes of positional plagiocephaly treatment. Clin Investig Med. 2012;35(5) Fludder CJ, Keil BG. Deformational plagiocephaly and reduced cervical spine range of motion: a retrospective case series of 150 infants in a paediatric chiropractic clinic. J Altern Ther Heal Med. 2020;26(12) Fludder CJ, Keil BG. Instrument-Assisted Delivery and the Prevalence of Reduced Cervical Spine Range of Motion. Chiropr J Aust. 2018;46:162-171 Pettersson K, Ajne J, Yousaf K, Sturm D, Westgren M, Ajne G. Traction force during vacuum extraction: a prospective observational study. BJOG An Int J Obstet Gynaecol. 2015;122(13):1809-1816 Triano JJ, Lester S, Starmer D, Hewitt EG. Manipulation Peak Forces Across Spinal Regions for Children Using Mannequin Simulators. J Manipulative Physiol Ther. 2017;40(3):139-146

The final episode in this trilogy delves into the advancement in laboratory techniques that allowed for more accurate measurements of immune complexes, leading to studies in the ‘50 and ‘60s that clearly demonstrated the potential pathogenicity of immune complex-mediated disease.  Brought to you by GSK. Intro :20 Recap and in this episode :40 The precipitant reaction 3:29 The antibody story 11:25 Frank Dixon 18:20 When did people start using these techniques? 20:15 On the quest to see if immune complexes are pathogenic 24:09 Frank Dixon's findings using radioactive iodine tagging 28:22 Episode wrap-up 29:00 Thanks for listening! 32:11 Disclosures: Brown reports no relevant financial disclosures. We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Germuth FG Jr, et al. Johns Hopkins Med J. 1967;120:225-251. Kano K, Milgrom F. Vox Sanguinis. 1980;38:121-137. McCluskey RT, et al. J Exp Med. 1960;111:181-194. Waksman BH. Medicine (Baltimore). 1962;41:93-141.

Referências1.Correa-de-Castro B, Pompilio MA, Odashiro DN, Odashiro M, Arao-Filho A, Paniago AM. Unifocal bone paracoccidioidomycosis, Brazil. Am J Trop Med Hyg. 2012;86(3):470-3.2.Franco FL, Niemeyer B, Marchiori E. Bone involvement in paracoccidioidomycosis. Rev Soc Bras Med Trop. 2019;52.3.Monsignore LM, Martinez R, Simao MN, Teixeira SR, Elias J, Jr., Nogueira-Barbosa MH. Radiologic findings of osteoarticular infection in paracoccidioidomycosis. Skeletal Radiol. 2012;41(2):203-8.4.Amstalden EM, Xavier R, Kattapuram SV, Bertolo MB, Swartz MN, Rosenberg AE. Paracoccidioidomycosis of bones and joints. A clinical, radiologic, and pathologic study of 9 cases. Medicine (Baltimore). 1996;75(4):213-25.5.Martins PAG, Rodrigues RS, Barreto MM. Involvement of bone in disseminated paracoccidioidomycosis. Rev Soc Bras Med Trop. 2021;54.6.de Freitas RS, Dantas KC, Garcia RS, Magri MM, de Andrade HF, Jr. Paracoccidioides brasiliensis causing a rib lesion in an adult AIDS patient. Hum Pathol. 2010;41(9):1350-4.7.Rosa Junior M, Baldon IV, Amorim AFC, Fonseca APA, Volpato R, Lourenco RB, et al. Imaging paracoccidioidomycosis: A pictorial review from head to toe. Eur J Radiol. 2018;103:147-62.8.Costa MAB, Carvalho TN, Araújo Junior, CRA, Borba AOC, Veloso GA, Texeira KSS. Manifestastações extrapulmonares da paracoccidioidomicose. Radiol Bras. 2005;38(1):45-52.9.Trad H., Trad CS, Elias Junior J, Muglia VF. Revisão Radiológica de 173 casos consecutivos de paracoccidioidomicose. Radiol Bras. 2005;39(3):175-9.

Reference1.Correa-de-Castro B, Pompilio MA, Odashiro DN, Odashiro M, Arao-Filho A, Paniago AM. Unifocal bone paracoccidioidomycosis, Brazil. Am J Trop Med Hyg. 2012;86(3):470-3.2.Franco FL, Niemeyer B, Marchiori E. Bone involvement in paracoccidioidomycosis. Rev Soc Bras Med Trop. 2019;52.3.Monsignore LM, Martinez R, Simao MN, Teixeira SR, Elias J, Jr., Nogueira-Barbosa MH. Radiologic findings of osteoarticular infection in paracoccidioidomycosis. Skeletal Radiol. 2012;41(2):203-8.4.Amstalden EM, Xavier R, Kattapuram SV, Bertolo MB, Swartz MN, Rosenberg AE. Paracoccidioidomycosis of bones and joints. A clinical, radiologic, and pathologic study of 9 cases. Medicine (Baltimore). 1996;75(4):213-25.5.Martins PAG, Rodrigues RS, Barreto MM. Involvement of bone in disseminated paracoccidioidomycosis. Rev Soc Bras Med Trop. 2021;54.6.de Freitas RS, Dantas KC, Garcia RS, Magri MM, de Andrade HF, Jr. Paracoccidioides brasiliensis causing a rib lesion in an adult AIDS patient. Hum Pathol. 2010;41(9):1350-4.7.Rosa Junior M, Baldon IV, Amorim AFC, Fonseca APA, Volpato R, Lourenco RB, et al. Imaging paracoccidioidomycosis: A pictorial review from head to toe. Eur J Radiol. 2018;103:147-62.8.Costa MAB, Carvalho TN, Araújo Junior, CRA, Borba AOC, Veloso GA, Texeira KSS. Manifestastações extrapulmonares da paracoccidioidomicose. Radiol Bras. 2005;38(1):45-52.9.Trad H., Trad CS, Elias Junior J, Muglia VF. Revisão Radiológica de 173 casos consecutivos de paracoccidioidomicose. Radiol Bras. 2005;39(3):175-9.

Contributor:  Jared Scott, MD Educational Pearls: Differential Diagnosis: non-accidental trauma, febrile seizure, meningitis, hyponatremia, epilepsy Convulsions with gastroenteritis is a known entity to cause seizures in infancy Predominantly occurs in ages 6 months to 3 years Occur with diarrheal episodes No electrolyte abnormalities associated with the seizure nor severe dehydration Seizures tend to come in clusters Most have a normal EEG and do not develop epilepsy Reported incidence in gastroenteritis of 1-2% of gastroenteritis Treatment addresses the seizures but long term anti-epileptic drugs are typically not needed References Kang B, Kwon YS. Benign convulsion with mild gastroenteritis. Korean J Pediatr. 2014;57(7):304-309. doi:10.3345/kjp.2014.57.7.304 Ma X, Luan S, Zhao Y, Lv X, Zhang R. Clinical characteristics and follow-up of benign convulsions with mild gastroenteritis among children. Medicine (Baltimore). 2019;98(2):e14082. doi:10.1097/MD.0000000000014082 Image credit: Kurt Christensen Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

The completion of the Endocarditis for the Rheumatologist trilogy! This episode focuses on the glomerulonephritis of endocarditis as well as the immunologic abnormalities you can see on labs. Brought to you by GSK. Consider the long-term impact of disease activity flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com. Intro :11 In this episode :22 Recap of previous episodes :39 About episode three 1:00 How labs can give a clue to endocarditis being a culprit 1:23 The immune complex nature of infective endocarditis 6:30 How do you measure immune complex? 9:10 What are the effects of immune complex formation on the organ systems? 12:37 Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Cryoglobulins and rheumatoid factor in infective endocarditis 15:12 The kidneys and infective endocarditis 16:45 Glomerulonephritis and infective endocarditis 24:15 ANCA-positive vasculitis and infective endocarditis 29:09 A summary of infective endocarditis 32:21 Takeaways 33:28 A preview of next episode 33:48 Conclusion 34:12 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bayer AS, et al. N Engl J Med. 1976;295:1500-1505. Boils CL, et al. Kidney Int. 2015;87:1241-1249. Forte WC, et al. Arq Bras Cardiol. 2001;76:43-52. Hurwitz D, et al. Clin Exp Immunol. 1975;19:131-141. Langlois V, et al. Medicine (Baltimore). 2016;95:e2564. Levy RL, Hong R. Am J Med. 1973;54:645-652. Ma T-T, et al. PLoS One. 2014;9: https://doi.org/10.1371/journal.pone.0097843. Messias-Reason IL, et al. Clin Exp Immunol. 2002;127:310-315. Petersdorf RG. N Engl J Med. 1976;295:1534-1535. Spain DM, King DW. Ann Intern Med. 1952;36:1086-1089. Williams Jr RC, Kunkel HG. J Clin Invest. 1962;41:666-675. Tire squealing sound effect by Mike Koenig.

Infectious endocarditis can present with rheumatic features in 15% to 25% of cases. This series focuses on what a rheumatologist should know about the clinical puzzle of endocarditis. Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Intro :11 In this episode :22 About episode one 2:33 How did people diagnose infectious endocarditis back in the day? 5:15 What is a Gulstonian Lecture? 6:25 So, who was Dr. Emanuel Libman? 13:33 Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. How Gustav Mahler’s endocarditis diagnosis was made 19:15 The evolution of diagnosing endocarditis 20:45 The story of Alfred S. Reinhart and his self-diagnosis of endocarditis 21:45 Clinical signs and symptoms of endocarditis and how they hold up today 28:00 Recap and a preview of next episode 33:20 Conclusion 35:15 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Flegel KM. CMAJ. 2002;167:1379-1383. Harrison's Principles of Internal Medicine, Nineteenth edition, McGraw-Hill Education, New York, 2015. Levy D. Br Med J (Clin Res Ed). 1986;293:1628-1631. Libman E, Celler HL. Am J Med Sci. 1910;140. Osler W. Br Med J. 1885;1:467-470. Parsons WB Jr, et al. J Am Med Assoc. 1953;153:14-16. Pelletier LL Jr, Petersdorf RG. Medicine (Baltimore). 1977;56:287-313. Ramin S. Hektoen International. 2013;5.

Dr. Charles Scarborough joins the show to discuss the story of his son Jude, and his family's experience with his son's diagnosis with 22q11 deletion syndrome.  In addition to hearing about the Scarborough's personal experience, we talk about the genetic considerations and common clinical manifestations of 22q11.2 deletion syndrome. How do you approach the general diagnostic testing and screening evaluation of a child with 22q11.2 deletion syndrome? We also discuss the impact that genetic and chronic disease has on our pediatric patients and their families. Thanks to Dr. Paul Mann, Dr. Liezl Domingo and Dr. Jacqueline Chan for providing guidance and peer review of the technical material in this episode.  Citation: Hodges, Z. (Host). Scarborough, C. (Host).  Mann, P. (Contributor). Chan, J. (Contributor). Domingo, L. (Contributor).  (2020, Nov 1). Jude's Story/22q11 Deletion Syndrome. (S1:17) [Audio Podcast Episode]. MCG Pediatric Podcast. Medical College of Georgia Augusta.   Links: MCG Pediatric Podcast: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php  Georgia Medicaid Katie Beckett: https://medicaid.georgia.gov/programs/all-programs/tefrakatie-beckett  Clinica La fuente in Cusco, Peru http://www.lafuenteclinica.com/clinic-ingles/  If you would like to donate to Clinica La fuente https://www.mtw.org/projects/details/pe-la-fuente-centro-de-salud-integral    Questions or comments? Contact us by email at mcgpediatricpodcast@augusta.edu    References: Cohen JL, Crowley TB, McGinn DE, et al. 22q and two: 22q11.2 deletion syndrome and coexisting conditions. Am J Med Genet A. 2018;176(10):2203-2214. doi:10.1002/ajmg.a.40494 Campbell IM, Sheppard SE, Crowley TB, et al. What is new with 22q? An update from the 22q and You Center at the Children's Hospital of Philadelphia. Am J Med Genet A. 2018;176(10):2058-2069. doi:10.1002/ajmg.a.40637 Vorstman JA, Jalali GR, Rappaport EF, Hacker AM, Scott C, Emanuel BS. MLPA: a rapid, reliable, and sensitive method for detection and analysis of abnormalities of 22q. Hum Mutat. 2006;27(8):814-821. doi:10.1002/humu.20330 McDonald-McGinn DM, Sullivan KE. Chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome). Medicine (Baltimore). 2011;90(1):1-18. doi:10.1097/MD.0b013e3182060469 Bassett AS, McDonald-McGinn DM, Devriendt K, et al. Practical guidelines for managing patients with 22q11.2 deletion syndrome.J Pediatr. 2011;159(2):332-9.e1. doi:10.1016/j.jpeds.2011.02.039

Video version of episode: https://www.youtube.com/watch?v=elzijduKNS8 Chubbyemu case: https://youtu.be/UrbylXMU8Mw Most snowglobes are just made of water, but some can contain ethylene glycol. Most of those usually don't contain enough ethylene glycol to cause damage, but keep the word "usually" in mind. A homemade snowglobe can contain concentrations of anything, which is what happened in this case. Ethylene glycol can cause a profound high anion gap metabolic acidosis, and we'll explain the science, chemistry and physiology behind that in this episode. References: Delayed ethylene glycol presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report. Journal of Medical Case Reports volume 4, Article number: 220 (2010). Multiple Cranial Nerve Deficits After Ethylene Glycol. Ann Emerg Med. 1991 Feb;20(2):208-10. https://pubmed.ncbi.nlm.nih.gov/1996809/ Antidotes OH that form toxic metabolites. Br J Clin Pharmacol. 2016 Mar; 81(3): 505–515. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767193/ Toxic Alcohols. N Engl J Med 2018; 378:270-280. https://www.nejm.org/doi/full/10.1056/NEJMra1615295 Ethylene glycol ingestion masked by concomitant ethanol ingestion. Case Reports 2012;2012:bcr1220115326. https://casereports.bmj.com/content/2012/bcr.12.2011.5326 Challenges in the Diagnosis of Ethylene Glycol Poisoning. Ann Clin Biochem. 2014 Mar;51(pt2):167-78. https://pubmed.ncbi.nlm.nih.gov/24215789/ Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore) 1977;56:38-54. Uribarri J, Oh MS, Carroll HJ. D-lactic acidosis: a review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Medicine (Baltimore) 1998;77:73-82. Judge BS. Metabolic acidosis: differentiating the causes in the poisoned patient. Med Clin North Am 2005;89:1107-1124. Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003;348:1786-1795. https://www.nejm.org/doi/full/10.1056/NEJMra020617 A 49 Year Old Man With Obtundation Followed By Agitation And Acidosis. N Engl J Med 2015; 372:465-473. https://www.nejm.org/doi/full/10.1056/NEJMcpc1410940 Integration of Acid-Base And Electrolyte Disorders. N Engl J Med 2014; 371:1821-1831. https://www.nejm.org/doi/full/10.1056/NEJMra1215672 Calcium Kidney Stones. N Engl J Med 2010; 363:954-963. https://www.nejm.org/doi/full/10.1056/NEJMcp1001011 --- Support this podcast: https://anchor.fm/chubbyemu/support

Traditional Approach:   Secretory -- poisoned mucosal villi -- "the sieve" Cytotoxic -- destroyed mucosal villi -- "the shred" Osmotic -- malabsorption -- "the pull" Inflammatory -- edema, motility -- "the push" Lots of overlap, difficult to apply to clinical signs and symptoms.   Bedside Approach: Fever/No Fever, Bloody/No Blood   Non-bloody, febrile -- most likely viral Non-bloody, afebrile -- may be viral Bloody, febrile -- likely bacterial Non-bloody, afebrile -- full stop.  Eval for Hemolytic Uremic Syndrome   Workup   Ask yourself -- again -- why is this not... appendicitis-torsion-intussusception-etc. Admit sick children, but most go home, so...   Non-bloody, febrile -- no workup necessary; precautionary advice  Non-bloody, afebrile -- be more skeptical, but generally same as above Bloody, febrile -- stool culture, follow up; do not treat empirically unless septic and admitted.  Culture will dictate treat/no treat/how. Bloody, afebrile -- evaluate for hemolytic uremic syndrome, especially if under 5 years old: CBC, chemistries, UA, stool culture   Evaluate Hydration Status                 Selected References Khan WA et al. Central Nervous System Manifestations of Childhood Shigellosis: Prevalence, Risk Factors, and Outcome. Pediatrics. 1999 Feb;103(2):E18 Lee JY et al. Diagnostic yield of stool culture and predictive factors for positive culture in patients with diarrheal illness. Medicine (Baltimore). 2017 Jul; 96(30): e7641. Nelson JD et al. Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin, or placebo. Pediatrics 1980; 65:1125.        

In this episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the age old question... whether or not to pursue a repeat epidural steroid injection (ESI) for the possibility of cumulative effect.   Historically there was a time when it was fairly common practice to order a pre-determined series of ESIs.  Over time, based on analysis of the research performed, and based on clinical experience, taking a more nuanced approach has proven to be the recommendation of most pain societies. Listen as the doctors discuss some of the available literature, as well as their clinical experience regarding this high yield / practical topic.   Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Lee JH, Lee SH. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?. Medicine (Baltimore). 2016;95(29):e4131. 2. Lee JH, Lee SH. Can Repeat Injection Provide Clinical Benefit in Patients with Lumbosacral Diseases When First Epidural Injection Results Only in Partial Response?. Pain Physician. 2016;19(2):E283-E290. 3. N. K. Arden, C. Price, I. Reading, J. Stubbing, J. Hazelgrove, C. Dunne, M. Michel, P. Rogers, C. Cooper, on behalf of the WEST Study Group, A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study, Rheumatology, Volume 44, Issue 11, November 2005, Pages 1399–1406. 4. Naveen S. Murthy, MD, Jennifer R. Geske, MS, Randy A. Shelerud, MD, John T. Wald, MD, Felix E. Diehn, MD, Kent R. Thielen, MD, Timothy J. Kaufmann, MD, Jonathan M. Morris, MD, Vance T. Lehman, MD, Kimberly K. Amrami, MD, Rickey E. Carter, PhD, Timothy P. Maus, MD, The Effectiveness of Repeat Lumbar Transforaminal Epidural Steroid Injections, Pain Medicine, Volume 15, Issue 10, October 2014, Pages 1686–1694

This episode dives into the rare Whipple’s disease, focusing on the articular manifestations of this infectious masquerader and when a rheumatologist should consider it in the differential. Brought to you by GSK. Considering a treatment change for patients with active SLE? Learn about a treatment option for your patients at treatfortodayandtomorrow.com. Intro :20 In this episode :28 Background on the organism 5:25 An important point when making the diagnosis 7:48 Who gets infected? 8:55 What is Whipple’s disease? 11:48 This disease is fatal 15:53 A look at the joints 16:28 What happens when you give these patients immunosuppression? 26:36 How to diagnose 28:38 Summary so far 31:00 Brought to you by GSK. Consider the long-term impact of disease activity, flares and corticosteroid use on patients with active SLE. Learn more now at treatfortodayandtomorrow.com Other organ manifestations of Whipple’s disease 32:08 Summary and take-home 44:36 Disclosure: Brown reports no relevant financial disclosures. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum References: Bousbia S, et al. Emerg Infect Dis. 2010;16:258-63. Chan RY, et al. Ophthalmology. 2001;108:2225-2231. Dobbins 3rd WO, et al. Arthritis Rheum. 1987;30:102-105. Durand DV, et al. Medicine (Baltimore). 1997;76:170-84. Fenollar F, et al. BMC Infect Dis. 2011;11:171. Feurle GE, et al. Eur J Clin Invest. 1979;9:385-389. Geissdörfer W, et al. J Clin Microbiol. 2012;50:216-22. Guérin A, et al. Elife. 2018;7:e32340. Heffner DK. Lancet. 2007;370:738-9; author reply 739. Keita AK, et al. PLoS Negl Trop Dis. 2011;5:e1403. Lagier JC, et al. Medicine (Baltimore). 2010;89:337-345. Lozupone C, et al. Am J Respir Crit Care Med. 2013;187:1110-7. McAllister Jr. HA, Fenoglio Jr. JJ. Circulation. 1975;52:152-6. O’Duffy JD, et al. Arthritis Rheum. 1999;42:812-817. Puéchal X. Joint Bone Spine. 2016;83:631-635. Puéchal X, et al. Arthritis Rheum. 2002;46:1130-1132. Puéchal X, et al. Arthritis Rheum. 2007;56:1713-1718. Raheja AA, et al. Clin Imaging. 2010;34:143-147. Ramos JM, et al. J Med Case Rep. 2015;9:165. Raoult D, et al. Emerg Infect Dis. 2010;16:776-82. Schöniger-Hekele M, et al. Appl Environ Microbiol. 2007;73:2033-2035. Stein A, et al. Am J Respir Crit Care Med. 2013;188:1036-7. Additional resource: Neurosigns.org’s video on oculomasticatory myorhythmia can be viewed at: https://www.youtube.com/watch?v=Zwb5bt749Jo

Author: Don Stader, MD Educational Pearls: Nasogastric tubes (NGT) are very uncomfortable for all those involved but some simple tricks and tips may help: Topical lidocaine can be inserted into the nasal passage for local analgesia Afrin may help shrink the mucosal tissue of the nasal turbinates as well Molding the tube with cold/ice water can help - putting it in an ice bath with an endotracheal tube stylet will allow you to mold the tip to your preference References Lor YC, Shih PC, Chen HH, et al. The application of lidocaine to alleviate the discomfort of nasogastric tube insertion: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(5):e9746. doi:10.1097/MD.0000000000009746 https://www.acepnow.com/article/making-ng-tube-placement-less-horrendous/ https://www.aliem.com/trick-of-trade-making-ng-and-np-painless/ Summarized and edited by Erik Verzemnieks, MD

Join the EMGuideWire team as they discuss Superior Vena Cava Syndrome! Shownotes: Definition: Any condition leading to obstruction of blood flow through the SVC Pathophysiology: Pathology in adjacent anatomy (lung, lymph node, thymus, mediastinum) or within the SVC itself obstructs venous return to the right atrium. As the SVC is compressed, venous collaterals form alternative pathways returning blood to the right atrium which can dilate over several weeks. As a result, upper body venous pressure increases, which in extreme cases lead to airway congestion and venous cerebrovascular congestion and edema. Hemomdynamic compromise is most often by direct compression of the heart, not from SVC obstruction. Risk factors: Indwelling device through the SVC (Central line, dialysis catheter, pacemaker) Lung cancer Lymphoma Thymoma Presentation: Signs – plethoric appearance, dilated neck and chest veins, swollen face/neck/chest Symptoms – congestive symptoms (head fullness, swelling), cardiopulmonary symptoms (chest pain, dyspnea, stridor, hoarseness), and neurologic symptoms (headache, confusion, obtundation, visual disturbances) Work-up: Is the patient unstalbe? Do they have severe SVC? If yes, secure airway, support breathing, support circulation Consult vascular/cardiothoracic surgery If patient is stable, then: Confirm diagnosis and evaluate for malignant obstruction CBC, CMP, PT/INR, CXR, CT chest w/contrast Does the patient have a malignant obstruction or thrombosis? Yes -> consult heme/onc and admit No -> observe in ED     References: García Mónaco R, Bertoni H, Pallota G, et al. Use of self-expanding vascular endoprostheses in superior vena cava syndrome. Eur J Cardiothorac Surg 2003; 24:208. Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore) 2006; 85:37. Schraufnagel DE, Hill R, Leech JA, Pare JA. Superior vena caval obstruction. Is it a medical emergency? Am J Med 1981; 70:1169. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med 2007; 356:1862.

Contributor: Jared Scott, MD Educational Pearls: Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushing, and parasthesias Common causes of SVC syndrome include lung cancer, lymphoma, and thymoma Keep SVC syndrome on the differential for all patients with facial or upper extremity swelling References The superior vena cava syndrome: clinical characteristics and evolving etiology. Rice TW, Rodriguez RM, Light RW. Medicine (Baltimore). 2006;85(1):37.  Diagnosis and management of superior vena cava syndrome. Markman M. Cleve Clin J Med. 1999;66(1):59.  Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD  

2019 was a big year. The year of the Mueller report. The American college admissions scandals. Brexit. But it was also the year the US Women's team won the World Cup, and lobbied for the equal pay of women and men in sports. It was the year of NMO, in which several pivotal trials showed benefit of disease modulating therapy in this condition. The year Will Smith played Genie in Aladdin. 2019 was a great year. And as we wrap up 2019, this week's episode includes some of the highlights. Enjoy! Produced by James E. Siegler with support from Erika Mejia, Rajat Dhar, and the entire Siegler family. Music courtesy of Axletree, Chris Zabriskie, John Paston, Kevin Mcleod, Josh Woodward, Steve Combs, Lee Rosevere, Scott Holmes, Advent Chamber Orchestra, Coldnoise, and Pachyderm. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES [BRAIN FOOD] Kennedy DO, Wightman EL, Reay JL, Lietz G, Okello EJ, Wilde A and Haskell CF. Effects of resveratrol on cerebral blood flow variables and cognitive performance in humans: a double-blind, placebo-controlled, crossover investigation. Am J Clin Nutr. 2010;91:1590-7. Devore EE, Kang JH, Breteler MM and Grodstein F. Dietary intakes of berries and flavonoids in relation to cognitive decline. Annals of neurology. 2012;72:135-43. Norton S, Matthews FE, Barnes DE, Yaffe K and Brayne C. Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. The Lancet Neurology. 2014;13:788-94. Morris MC, Tangney CC, Wang Y, Sacks FM, Barnes LL, Bennett DA and Aggarwal NT. MIND diet slows cognitive decline with aging. Alzheimers Dement. 2015;11:1015-22. Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martinez-Gonzalez MA, Martinez-Lapiscina EH, Fito M, Perez-Heras A, Salas-Salvado J, Estruch R and Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA internal medicine. 2015;175:1094-1103. Newman JC, Covarrubias AJ, Zhao M, Yu X, Gut P, Ng CP, Huang Y, Haldar S and Verdin E. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice. Cell Metab. 2017;26:547-557 e8. Miller MG, Hamilton DA, Joseph JA and Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial. Eur J Nutr. 2018;57:1169-1180. Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmuller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM and consortium O. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. The Lancet Neurology. 2018;17:671-680. Radd-Vagenas S, Duffy SL, Naismith SL, Brew BJ, Flood VM and Fiatarone Singh MA. Effect of the Mediterranean diet on cognition and brain morphology and function: a systematic review of randomized controlled trials. Am J Clin Nutr. 2018;107:389-404. Xu W, Wang H, Wan Y, Tan C, Li J, Tan L and Yu JT. Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;32:31-42. Lefevre-Arbogast S, Gaudout D, Bensalem J, Letenneur L, Dartigues JF, Hejblum BP, Feart C, Delcourt C and Samieri C. Pattern of polyphenol intake and the long-term risk of dementia in older persons. Neurology. 2018;90:e1979-e1988. Liu QP, Wu YF, Cheng HY, Xia T, Ding H, Wang H, Wang ZM and Xu Y. Habitual coffee consumption and risk of cognitive decline/dementia: A systematic review and meta-analysis of prospective cohort studies. Nutrition. 2016;32:628-36. [OF MEASLES AND MEN] Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Valentine A, Davies SE and Walker-Smith JA. Retraction of an interpretation. Lancet. 2004;363:750. Perry RT and Halsey NA. The clinical significance of measles: a review. The Journal of infectious diseases. 2004;189 Suppl 1:S4-16. Campbell H, Andrews N, Brown KE and Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36:1334-48. Poland GA and Jacobson RM. The age-old struggle against the antivaccinationists. The New England journal of medicine. 2011;364:97-9. Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB and Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics. 2014;134:325-37. Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016;170:1209-1215. Bester JC. Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics. 2018;32:611-619. Fournet N, Mollema L, Ruijs WL, Harmsen IA, Keck F, Durand JY, Cunha MP, Wamsiedel M, Reis R, French J, Smit EG, Kitching A and van Steenbergen JE. Under-vaccinated groups in Europe and their beliefs, attitudes and reasons for non-vaccination; two systematic reviews. BMC Public Health. 2018;18:196.  Trump’s tweet: https://twitter.com/realdonaldtrump/status/449525268529815552?lang=en [NON-INFECTIOUS NEUROLOGIC COMPLICATIONS OF ORGAN TRANSPLANT] Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78. Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572. Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D and Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10:908-14. Munoz P, Valerio M, Palomo J, Fernandez-Yanez J, Fernandez-Cruz A, Guinea J and Bouza E. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore). 2010;89:166-75. Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V and Chen Y. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010;64:169-77. Dhar R, Young GB and Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocritical care. 2008;8:253-8.

In this episode of GPWorks, ICGP Quality and Policy Manager Dr Helen McVeigh talks to Dr Deirdre Johnston from the Department of Psychiatry and Behavioural Sciences in John Hopkins University School of Medicine Baltimore. Deirdre talks about the experience she gained during her career; from training in medicine in Galway to moving to Alberta Canada specialising in psychiatry for the elderly.

In the second half of our two-part series on complications of organ transplantation, Dr. Raj Dhar (Neurocritical Care, Washington University in St. Louis) discusses his experience managing the non-infectious complications of organ transplantation--from drug toxicities to multi-disciplinary medical care. Produced by James E. Siegler and Raj Dhar. Music by Steve Combs, Lee Rosevere, and Scott Holmes. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Senzolo M, Ferronato C and Burra P. Neurologic complications after solid organ transplantation. Transpl Int. 2009;22:269-78. Dhar R. Neurologic complications of transplantation. Handbook of clinical neurology. 2017;141:545-572. Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D and Wijdicks EF. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10:908-14. Munoz P, Valerio M, Palomo J, Fernandez-Yanez J, Fernandez-Cruz A, Guinea J and Bouza E. Infectious and non-infectious neurologic complications in heart transplant recipients. Medicine (Baltimore). 2010;89:166-75. Wu Q, Marescaux C, Wolff V, Jeung MY, Kessler R, Lauer V and Chen Y. Tacrolimus-associated posterior reversible encephalopathy syndrome after solid organ transplantation. Eur Neurol. 2010;64:169-77. Dhar R, Young GB and Marotta P. Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocritical care. 2008;8:253-8.

Author: Don Stader, MD Educational Pearls:   Three options for a blister in partial thickness burns:  do nothing, unroof it, or poke a hole in it Recent study suggest that aspirating the blister may be more effective in regards to wound healing The overlying skin acts as a bio-band-aid and patients recover slightly faster References: Ro HS, Shin JY, Sabbagh MD, Roh SG, Chang SC, Lee NH. Effectiveness of aspiration or deroofing for blister management in patients with burns: A prospective randomized controlled trial. Medicine (Baltimore). 2018 Apr;97(17):e0563. doi: 10.1097/MD.0000000000010563. PubMed PMID: 29703044; PubMed Central PMCID: PMC5944508. Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

This episode discusses the case of an 85-year-old man with a history of hypertension and fairly recently diagnosed bladder cancer who presents with oligoarticular asymmetric inflammatory arthritis. Explore the details of this case and learn how bacillus Calmette-Guérin and reactive arthritis are related in this diagnostic conundrum. Intro :10 An 85-year-old man with a history of hypertension and recently diagnosed bladder cancer presents with oligoarticular asymmetric inflammatory arthritis :18 Details of his cancer history :32 How BCG (bacillus Calmette-Guérin) is used for superficial bladder cancer :53 Patient wakes with acute onset, rapidly progressing joint pain 1:21 Results of synovial aspiration of his right wrist 2:06 Physical exam findings and patient history 2:24 Discharged from outside hospital 2:53 Outpatient rheumatologist orders autoimmune serologies 3:03 Second hospital admission 3:24 Infectious disease evaluation 4:25 Patient presents to Cleveland Clinic 4:54 What do we have? 6:18 The main concern is he’s been instilled with bacteria 6:45 Could this be a reactive arthritis? 7:18 History of BCG 7:45 What do we know about what happens to these patients? 10:28 How do we define disseminated BCG infection vs. a reactive arthritis? 10:58 A single institution cohort of disseminated infection after BCG instillation 11:29 Comparing these definitions in our patient 14:34 A look at reactive arthritis 15:07 What do we use to treat these patients? 16:12 A look back at our patient 16:31 Continued treatment with triple therapy 17:05 A diagnostic conundrum 17:32 The diagnosis, in hindsight 18:11 Summary 18:49 We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. References: Bernini L. Autoimmun Rev. 2013;12:1150-1159. Meyer J. Postgrad Med J. 2002;78:449-454. Pérez-Jacoiste Asín MA. Medicine (Baltimore). 2014;93:236-254. To U. Case Rep Med. 2014;doi:10.1155/2014/362845. 

A young woman presents with migraine-like headaches, black spots in her vision and emotional lability. Think you know the diagnosis? You may be surprised – this medical mystery is not what it seems. In this episode, learn more about this rare diagnosis, and gain clinical insight from neurologist Devon Conway, MD, and ophthalmologist Arthi Venkat, MD. Intro :11 A 24-year-old woman presents with gradual worsening of a migraine-like headache accompanied by nausea :22 Description of symptoms :37 ER visit 1:23 Onset of new symptoms 1:44 Second ER visit 2:11 Outpatient MRI findings 2:28 Lumbar puncture findings 2:50 Patient is admitted to hospital 3:52 Second MRI findings 4:16 Ophthalmology consult and results of fluorescein angiography 4:46 Audiogram is ordered 5:17 Case summary 5:40 What is the most likely diagnosis? 6:05 Triad of Susac syndrome 6:27 Remember: This is not a vasculitis 7:11 History of Susac syndrome 7:40 CNS manifestations of the Susac triad 8:27 Consult with Devon Conway, MD 10:13 Flare signals for non-radiologists/neurologists 11:05 Anything specific that says “demyelinating” on MRI? 13:35 Distinguishing the lesions in this case from those of MS 15:36 Neurology work-up approach to this type of case 16:28 The utility of lumbar puncture in this situation 18:05 About ADEM (acute disseminated encephalomyelitis) 21:06 Ocular manifestations of Susac syndrome 22:26 Consult with Arthi Venkat, MD 23:17 Ophthalmology differential in a patient with intermittent vision loss in various fields of vision 23:55 Overview of branch retinal artery occlusions 25:22 Difference between branch retinal artery occlusions and other ophthalmologic presentations common to rheumatologists 27:51 How the ophthalmologic exam helps differentiate MS from Susac syndrome 30:07 Overview of sensorineural hearing loss in Susac syndrome 34:09 Do we know for sure this is an autoimmune disease? 34:59 Aggressive immunosuppression seems to halt the progression of disease 35:34 What are treatment options? 35:42 What do we know about long-term outcomes? 36:31 Who takes care of these patients? 37:29 Treatment, outcome of this patient 38:07 Episode/case summary 38:20 Devon Conway, MD, is a staff neurologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis. Arthi Venkat, MD, is a retinal and uveitis specialist at Cole Eye Institute at Cleveland Clinic. We’d love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. References: Aubart-Cohen F, et al. Medicine (Baltimore). 2007;86:93-102. Greco A, et al. Autoimmun Rev. 2014;13:814-821. Rennebohm RM, et al. Int J Stroke. 2018;doi:10.1177/1747493017751737.

Rich Levitan is an Adjunct Professor of Emergency Medicine at Dartmouth School of Medicine (New Hampshire) and visiting Professor at University of Maryland School of Medicine (Baltimore, Maryland). Professor Levitan is director of the New York City Airway Course, the Yellowstone Airway Course and the worlds largest cadaver airway course, in Baltimore (monthly for 16 years). He has given more than 350 invited international lectures on airway management and authored 42 publications and 3 textbooks on airway management. He is the inventor of the AirwayCam, which captured real-time, advanced airway skills for the first time. These resources have been used in 4000 hospitals in 26 different countries.