POPULARITY
4 episodes with mmwr morb mortal wkly rep
4 episodes with mmwr morb mortal wkly rep
2 episodes with mmwr morb mortal wkly rep
2 episodes with mmwr morb mortal wkly rep
2 episodes with mmwr morb mortal wkly rep
2 episodes with mmwr morb mortal wkly rep
Overview: In this episode, Dr Joel Gallant gives a history of antiretroviral therapy and HIV drug resistance, drawing on his personal and professional experience beginning in the early 1980s. The views expressed are those of the panelist and not necessarily Gilead Sciences, Inc. The information provided in this podcast is not intended to be and should not be understood to provide medical advice. Listeners should note that our discussions in this episode are relevant to the USA only and may not be appropriate for other regions. This episode was recorded in August 2023 and the content reflects the information available at that time. Guest: Joel Gallant, MD, MPH For more information, please visit: https://www.pri-med.com/clinical-resources/curriculum/hiv-in-focus References AIDSVu.org. New HIV diagnoses. 2023. Available from: https://aidsvu.org/local-data/united-states/south/ (Accessed May 19, 2025) AIDSVu.org was developed by the Rollins School of Public Health at Emory University in partnership with Gilead Sciences, Inc. Alonso A, de Irala J. Strategies in HIV prevention: the A-B-C approach. Lancet 2004;364:1033. Available from: https://doi.org/10.1016/s0140-6736(04)17050-5 Bacheler L, Jeffrey S, Hanna G et al. Genotypic correlates of phenotypic resistance to efavirenz in virus isolates from patients failing nonnucleoside reverse transcriptase inhibitor therapy. J Virol 2001;75:4999–5008. Available from: https://doi.org/10.1128/jvi.75.11.4999-5008.2001 Barré-Sinoussi F, Chermann JC, Rey F et al. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science 1983;220:868–71. Available from: https://doi.org/10.1126/science.6189183 Bayer R, Edington C. HIV testing, human rights, and global AIDS policy: exceptionalism and its discontents. J Health Polit Policy Law 2009;34:301–23. Available from: https://doi.org/10.1215/03616878-2009-002 Centers for Disease Control and Prevention. Pneumocystis pneumonia – Los Angeles. MMWR Morb Mortal Wkly Rep 1981;30:250-2. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm Centers for Disease Control and Prevention. Preventing HIV. 2024. Available from: https://www.cdc.gov/hiv/prevention/index.html (Accessed May 22, 2025) Cohen MS, Chen YQ, McCauley M et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493–505. Available from: https://doi.org/10.1056/NEJMoa1105243 Cuevas JM, Geller R, Garijo R et al. Extremely high mutation rate of HIV-1 in vivo. PLoS Biol 2015;13:e1002251. Available from: https://doi.org/10.1371/journal.pbio.1002251 Department of Health and Human Services. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. 2024. Available from: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/optimizing-antiretroviral-therapy (Accessed May 19, 2025) Dragovic G. Acute pancreatitis in HIV/AIDS patients: an issue of concern. Asian Pac J Trop Biomed 2013;3:422–425. Available from: https://doi.org/10.1016%2FS2221-1691(13)60091-X Eron JJ, Benoit SL, Jemsek J et al. Treatment with lamivudine, zidovudine, or both in HIV-positive patients with 200 to 500 CD4+ cells per cubic millimeter. North American HIV Working Party. N Engl J Med 1995;333:1662–9. Available from: https://doi.org/10.1056/nejm199512213332502 Gandhi RT, Tashima KT, Smeaton LM et al. Long-term outcomes in a large randomized trial of HIV-1 salvage therapy: 96-week results of AIDS clinical trials group A5241 (OPTIONS). J Infect Dis 2020;221:1407–15. Available from: https://doi.org/10.1093/infdis/jiz281 Getting to Zero San Francisco. HIV epidemiology annual report 2017. 2022. Available from: https://gettingtozerosf.org/getting-to-zero-resources/hiv-report-2017/ (Accessed May 22, 2025) Global Fund. About the Global Fund. 2024. Available from: https://www.theglobalfund.org/en/about-the-global-fund/ (Accessed May 19, 2025) Gulick RM, Lalezari J, Goodrich J et al. Maraviroc for previously treated patients with R5 HIV-1 infection. N Engl J Med 2008;359:1429–41. Available from: https://doi.org/10.1056/NEJMoa0803152 Gulick RM, Mellors JW, Havlir D et al. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med 1997;337:734–9. Available from: https://doi.org/10.1056/nejm199709113371102 Haubrich R, Berger D, Chiliade P et al. Week 24 efficacy and safety of TMC114/ritonavir in treatment-experienced HIV patients. AIDS 2007;21:F11–8. Available from: https://doi.org/10.1097/QAD.0b013e3280b07b47 HIV Prevention Trials Network. HPTN 052. 2023. Available from: https://www.hptn.org/research/studies/hptn052 (Accessed May 19, 2025) HIV.gov. HIV and AIDS timeline. 2024. Available from: https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline/ (Accessed May 19, 2025) HIVinfo.NIH.gov. FDA approval of HIV medicines. 2024. Available from: https://hivinfo.nih.gov/understanding-hiv/infographics/fda-approval-hiv-medicines (Accessed May 19, 2025) i-base. Cross-resistance by drug class. 2025. Available from: https://i-base.info/guides/changing/cross-resistance (Accessed May 19, 2025) Iyidogan P, Anderson KS. Current perspectives on HIV-1 antiretroviral drug resistance. Viruses 2014;6:4095–139. Available from: https://doi.org/10.3390/v6104095 Lalezari JP, Henry K, O'Hearn M et al. Enfuvirtide, an HIV-1 fusion inhibitor, for drug-resistant HIV infection in North and South America. N Engl J Med 2003;348:2175–85. Available from: https://doi.org/10.1056/NEJMoa035026 Landovitz RJ, Donnell D, Clement ME et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med 2021;385:595–608. Available from: https://doi.org/10.1056/NEJMoa2101016 Larder BA, Darby G, Richman DD. HIV with reduced sensitivity to zidovudine (AZT) isolated during prolonged therapy. Science 1989;243:1731–4. Available from: https://doi.org/10.1126/science.2467383 Lau B, Gange SJ, Moore RD. Risk of non-AIDS-related mortality may exceed risk of AIDS-related mortality among individuals enrolling into care with CD4+ counts greater than 200 cells/mm3. J Acquir Immune Defic Syndr 2007;44:179–87. Available from: https://doi.org/10.1097/01.qai.0000247229.68246.c5 Lucas C. The San Francisco model and the nurses of Ward 5B. Lancet HIV 2019;6:E819. Available from: https://doi.org/10.1016/S2352-3018(19)30267-X Madruga JV, Cahn P, Grinsztejn B et al. Efficacy and safety of TMC125 (etravirine) in treatment-experienced HIV-1-infected patients in DUET-1: 24-week results from a randomised, double-blind, placebo-controlled trial. Lancet 2007;370:29–38. Available from: https://doi.org/10.1016/s0140-6736(07)61047-2 Marcelin AG. Resistance to nucleoside reverse transcriptase inhibitors. In: Geretti AM, editor. Antiretroviral Resistance in Clinical Practice. London: Mediscript; 2006. Chapter 1. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2241/ Margolis AM, Heverling H, Pham PA et al. A review of the toxicity of HIV medications. J Med Toxicol 2014;10:26–39. Available from: https://doi.org/10.1007/s13181-013-0325-8 Moore RD, Creagh-Kirk T, Keruly J et al. Long-term safety and efficacy of zidovudine in patients with advanced human immunodeficiency virus disease. Zidovudine Epidemiology Study Group. Arch Intern Med 1991;151:981–6. Available from: https://doi.org/10.1001/archinte.1991.00400050123023 National Institute of Allergy and Infectious Diseases. HIV Undetectable = Untransmittable (U = U), or treatment as prevention. 2019. Available from: https://www.niaid.nih.gov/diseases-conditions/treatment-prevention (Accessed May 19, 2025) Nelson MR, Katlama C, Montaner JS et al. The safety of […] for the treatment of HIV infection in adults: the first 4 years. AIDS 2007;21:1273–81. Available from: https://doi.org/10.1097/QAD.0b013e3280b07b33 New York State Department of Health. Pre-exposure prophylaxis (PrEP) to prevent HIV infection: question and answers. 2012. Available from: https://www.health.ny.gov/publications/0265/ (Accessed May 22, 2025) Overton ET, Richmond G, Rizzardini G et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with human immunodeficiency virus 1 type 1 infection: 152-week results from ATLAS-2M, a randomized, open-label, phase 3b, noninferiority study. Clin Infect Dis 2023;76:1646–54. Available from: https://doi.org/10.1093/cid/ciad020 Pollak EB, Parmar M. Indinavir. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554396/ (Accessed May 19, 2025) Richman DD, Fischl MA, Grieco MH et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med 1987;317:192–7. Available from: https://doi.org/10.1056/nejm198707233170402 Schmit JC, Ruiz L, Clotet B et al. Resistance-related mutations in the HIV-1 protease gene of patients treated for 1 year with the protease inhibitor ritonavir (ABT-538). AIDS 1996;10:995–9. Available from: https://doi.org/10.1097/00002030-199610090-00010 Siliciano JD, Kajdas J, Finzi D et al. Long-term follow-up studies confirm the stability of the latent reservoir for HIV-1 in resting CD4+ T cells. Nat Med 2003;9:727–8. Available from: https://doi.org/10.1038/nm880 Steigbigel RT, Cooper DA, Kumar PN et al. Raltegravir with optimized background therapy for resistant HIV-1 infection. N Engl J Med 2008;359:339–54. Available from: https://doi.org/10.1056/NEJMoa0708975 TIME. Man of the year. 1996. Available from: https://time.com/vault/issue/1996-12-30/page/1/ (Accessed May 19, 2025) U.S. President's Emergency Plan for AIDS Relief (PEPFAR). About us. 2025. Available from: https://www.state.gov/about-us-pepfar/ (Accessed May 19, 2025)
Overview: In this episode, Dr Melissa Jones and Dr Christian Ramers discuss the importance of pan-viral screening for HIV and hepatitis. They emphasize the need for integrated testing and prevention strategies and the current barriers to implementation. The views expressed are those of the panelist(s) and not necessarily Gilead Sciences, Inc. The information provided in this podcast is not intended to be and should not be understood to provide medical advice. Listeners should note that our discussions in this episode are relevant to the USA only and may not be appropriate for other regions. This episode was recorded in August 2025 and the content reflects the information available at that time. Guest: Christian B Ramers, MD, MPH, FIDSA, AAHIVS; Melissa Jones, DNP, APRN-BC For more information, please visit: https://www.pri-med.com/clinical-resources/curriculum/hiv-in-focus References AASLD/IDSA. HCV guidance: recommendations for testing, managing, and treating hepatitis C. 2025. Available from: https://www.hcvguidelines.org/ (Accessed June 10, 2025). Arora DR et al. ISRN AIDS 2013;2013:287269 Alter MJ. J Hepatol 2006;44:S6–9. Bazargan M, Cobb BMS, Assari S. Ann Fam Med 2021;19:4–15. Beard N, Hill A. Open Forum Infect Dis 2024;11:ofad666. Bottero J, Boyd A, Gozlan J et al. Open Forum Infect Dis 2015;2:ofv162. Brunetto, Maurizia Rossana et al. J Hepatol 2023;79:433–60. Calabrese SK, Krakower DS, Mayer KH. Am J Public Health 2017;107:1883–89. CDC. Status neutral HIV care and service delivery eliminating stigma and reducing health disparities. 2022. Available from: https://stacks.cdc.gov/view/cdc/129024 (Accessed June 10, 2025). CDC. Clinical guidance for PrEP. 2025. Available from: https://www.cdc.gov/hivnexus/hcp/prep/index.html (Accessed June 10, 2025). CDC. Clinical screening and diagnosis for hepatitis C. 2025. Available from: https://www.cdc.gov/hepatitis-c/hcp/diagnosis-testing (Accessed June 10, 2025). CDC. Clinical testing and diagnosis for hepatitis B. 2025. Available from: https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/ (Accessed June 10, 2025). CDC. Clinical testing guidance for HIV. 2025. Available from: https://www.cdc.gov/hivnexus/hcp/diagnosis-testing/index.html (Accessed June 10, 2025). CDC. Getting tested for HIV. 2025. Available from: https://www.cdc.gov/hiv/testing/ (Accessed June 10, 2025). CDC. Hepatitis A vaccine. 2025. Available from: https://www.cdc.gov/hepatitis-a/vaccination/index.html (Accessed June 10, 2025). CDC. Hepatitis B vaccine. 2025. Available from: https://www.cdc.gov/hepatitis-b/vaccination/index.html (Accessed June 10, 2025). CDC. HIV infection among heterosexuals at increased risk--United States, 2010. MMWR Morb Mortal Wkly Rep 2013;62:183-8. CDC. Viral hepatitis among people with HIV. 2025. Available from: https://www.cdc.gov/hepatitis/hcp/populations-settings/hiv.html (Accessed June 10, 2025. Clinical info HIV.gov. Considerations for Antiretroviral Use in People With Coinfections, Hepatitis B Virus/HIV Coinfection. 2024. Available from: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/hepatitis-b-virus-hiv-coinfection (Accessed July 21, 2025). Cornberg M, Sandmann L, Jaroszewicz J et al. J Hepatol 2025; doi: 10.1016/j.jhep.2025.03.018. Coukan F, Murray KK, Papageorgiou V et al. HIV Med 2023;24:893–913. DHHS. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. 2024. Available from: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf (Accessed June 25, 2025). GHTF. Breaking the silence: combating stigma and misinformation in the fight against hepatitis. 2024. Available from: https://www.globalhep.org/news-blogs/breaking-silence-combating-stigma-and-misinformation-fight-against-hepatitis (Accessed June 10, 2025) Grieb SM, Harris R, Rosecrans A et al. Ann Med 2022;54:138–49. HIV.gov. US statistics. 2025. Available from: https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics (Accessed June 10, 2025). Kitt H et al. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2024 report. 2024. Available from https://www.gov.uk/government/statistics/hiv-annual-data-tables/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2024-report (Accessed June 10, 2025) Mayer KH, Agwu A, Malebranche D. Adv Ther 2020;37:1778–811. Mohareb AM, Larmarange J, Kim AY et al. Lancet HIV 2022;9:e585–e94. Moorman AC, Bixler D, Teshale EH et al. Public Health Rep 2023; doi: 10.1177/00333549231181348 Orkin, C. Open Forum Infect Dis 2024;11:ofad668. Post Z et al. Clin Liver Dis 2023;27:973-84 Saleska JL, Lee SJ. JAMA Pediatr 2020;174:1133–34. Symum H, Van Handel M, Sandul A et al. Prev Med Rep 2024;44:102777. UNAIDS. Global HIV & AIDS statistics — Fact sheet. 2025. Available from: https://www.unaids.org/en/resources/fact-sheet (Accessed July 18, 2025). UNM. Project ECHO. 2025. Available from: https://projectecho.unm.edu/ (Accessed June 10, 2025). Wejnert C et al. MMWR Morb Mortal Wkly Rep. 2016;65:1336–1342 WHO. Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations (Geneva). 2022. Available from: https://www.who.int/publications/i/item/9789240052390 (Accessed June 10, 2025). WHO. Fact sheet: hepatitis A. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-a (Accessed June 10, 2025). WHO. Fact sheet: hepatitis B. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b (Accessed July 18, 2025). WHO. Fact sheet: hepatitis D. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-d (Accessed June 10, 2025). WHO. Guidelines on HIV self-testing and partner notification: a supplement to the consolidated guidelines on HIV testing services. 2016. Available from: https://iris.who.int/handle/10665/251655 (Accessed June 10, 2025). WHO. Recommendations and guidance on hepatitis C virus self-testing. 2021. Available from: https://www.who.int/publications/i/item/9789240031128 (Accessed June 10, 2025). Xiao Y et al. Cells. 2020;9:2233
Os vírus respiratórios COVID-19, Influenza e VSR (Vírus Sincicial Respiratório) continuam a definir diagnósticos e internações. Se destacam como os mais relevantes nos últimos dados epidemiologicos quando falamos de pneumonia viral . Neste episódio do InfectoCast, William e João analisam a sazonalidade recente no Brasil, discutem formas práticas do uso dos testes rápidos e destacam como o subdiagnóstico interfere em condutas clínicas e medidas de isolamento. Também exploram o uso racional de antivirais na COVID-19, a profilaxia pós-exposição na Influenza e as novidades em imunização contra o VSR, reforçando o papel desses vírus no raciocínio infectológico atual.▶️ Confira o episódio completo e atualize sua prática frente às infecções respiratórias mais relevantes.Referências do episódioReferência citada aos 13:3BRASIL. Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). Vacina contra vírus sincicial respiratório em gestantes para prevenção de bronquiolite em lactentes. Parecer Técnico, 2024. Disponível em: https://www.gov.br/conitec.Referência citada aos 26:03CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC). COVID-19 vaccine effectiveness against emergency department visits, urgent care visits, and hospitalizations among adults — United States, 2024. MMWR Morb Mortal Wkly Rep, v. 73, n. 10, p. 250-257, 2024. doi:10.15585/mmwr.mm7310a2.Referência citada aos 11:30MC DONAGH, T.A. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, v. 42, n. 36, p. 3599–3726, 2021. doi:10.1093/eurheartj/ehab368.Referências sobre nirmatrelvir/ritonavir (Paxlovid):1.Amani B, Amani B. Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID‐19: A rapid review and meta‐analysis. Journal of Medical Virology. 2023 Jan 10;95(2).2.Tian H, Yang C, Song T, Zhou K, Wen L, Tian Y, et al. Efficacy and safety of paxlovid (nirmatrelvir/ritonavir) in the treatment of COVID‐19: An updated meta‐analysis and trial sequential analysis. Reviews in Medical Virology. 2023 Jul 23;33(5).
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-450 Overview: Use of e-cigarettes has increased significantly over the last several years and their popularity continues to grow, notably among adolescents and young adults. Recent evidence indicates that the majority of teens and young adults who vape consider quitting; however, nicotine addiction has historically been difficult to treat in this population. Join us as we discuss the prevalence of vaping, associated harms, and new evidence on the effectiveness of varenicline on cessation. Episode resource links: CDC https://www.cdc.gov/tobacco/e-cigarettes/youth.html Evins, A. E., Cather, C., Reeder, H. T., Evohr, B., Potter, K., Pachas, G. N., Gray, K. M., Levy, S., Rigotti, N. A., Iroegbulem, V., Dufour, J., Casottana, K., Costello, M. A., Gilman, J. M., & Schuster, R. M. (2025). Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial. JAMA, e253810. Advance online publication. https://doi.org/10.1001/jama.2025.3810 Lindson N, Butler AR, McRobbie H, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2024;1(1):CD010216. Published 2024 Jan 8. doi:10.1002/14651858.CD010216.pub8 Park-Lee E, Ren C, Sawdey MD, et al. Notes from the Field: E-Cigarette Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1387–1389. DOI: http://dx.doi.org/10.15585/mmwr.mm7039a4external icon; Tuisku A, Rahkola M, Nieminen P, Toljamo T. Electronic Cigarettes vs Varenicline for Smoking Cessation in Adults: A Randomized Clinical Trial. JAMA Intern Med. 2024;184(8):915–921. doi:10.1001/jamainternmed.2024.1822 Zhang, L., Gentzke, A., Trivers, K. F., & VanFrank, B. (2022). Tobacco Cessation Behaviors Among U.S. Middle and High School Students, 2020. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 70(1), 147–154. https://doi.org/10.1016/j.jadohealth.2021.07.011 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-450 Overview: Use of e-cigarettes has increased significantly over the last several years and their popularity continues to grow, notably among adolescents and young adults. Recent evidence indicates that the majority of teens and young adults who vape consider quitting; however, nicotine addiction has historically been difficult to treat in this population. Join us as we discuss the prevalence of vaping, associated harms, and new evidence on the effectiveness of varenicline on cessation. Episode resource links: CDC https://www.cdc.gov/tobacco/e-cigarettes/youth.html Evins, A. E., Cather, C., Reeder, H. T., Evohr, B., Potter, K., Pachas, G. N., Gray, K. M., Levy, S., Rigotti, N. A., Iroegbulem, V., Dufour, J., Casottana, K., Costello, M. A., Gilman, J. M., & Schuster, R. M. (2025). Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial. JAMA, e253810. Advance online publication. https://doi.org/10.1001/jama.2025.3810 Lindson N, Butler AR, McRobbie H, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2024;1(1):CD010216. Published 2024 Jan 8. doi:10.1002/14651858.CD010216.pub8 Park-Lee E, Ren C, Sawdey MD, et al. Notes from the Field: E-Cigarette Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1387–1389. DOI: http://dx.doi.org/10.15585/mmwr.mm7039a4external icon; Tuisku A, Rahkola M, Nieminen P, Toljamo T. Electronic Cigarettes vs Varenicline for Smoking Cessation in Adults: A Randomized Clinical Trial. JAMA Intern Med. 2024;184(8):915–921. doi:10.1001/jamainternmed.2024.1822 Zhang, L., Gentzke, A., Trivers, K. F., & VanFrank, B. (2022). Tobacco Cessation Behaviors Among U.S. Middle and High School Students, 2020. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 70(1), 147–154. https://doi.org/10.1016/j.jadohealth.2021.07.011 Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-437 Overview: This episode reviews the remarkable impact of the human papillomavirus (HPV) vaccine from 2008–2022, including significant declines in cervical precancer rates. Tune in for key data insights and updated HPV vaccination guidelines to help you close care gaps and strengthen cancer prevention efforts in your practice. Episode resource links: Gargano JW, Stefanos R, Dahl RM, et al. Trends in Cervical Precancers Identified Through Population-Based Surveillance — Human Papillomavirus Vaccine Impact Monitoring Project, Five Sites, United States, 2008–2022. MMWR Morb Mortal Wkly Rep 2025;74:96–101. DOI: http://dx.doi.org/10.15585/mmwr.mm7406a4 • HPV Vaccination Recommendations: Dosing and Schedule • Talking to parents about HPV vaccine Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-437 Overview: This episode reviews the remarkable impact of the human papillomavirus (HPV) vaccine from 2008–2022, including significant declines in cervical precancer rates. Tune in for key data insights and updated HPV vaccination guidelines to help you close care gaps and strengthen cancer prevention efforts in your practice. Episode resource links: Gargano JW, Stefanos R, Dahl RM, et al. Trends in Cervical Precancers Identified Through Population-Based Surveillance — Human Papillomavirus Vaccine Impact Monitoring Project, Five Sites, United States, 2008–2022. MMWR Morb Mortal Wkly Rep 2025;74:96–101. DOI: http://dx.doi.org/10.15585/mmwr.mm7406a4 • HPV Vaccination Recommendations: Dosing and Schedule • Talking to parents about HPV vaccine Guest: Jill M. Terrien PhD, ANP-BC Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com
Meslinger har vært en fryktet og hyppig forekommende sykdom opp gjennom historien. I moderne tid og med effektiv vaksine falt forekomsten – men i senere år har man sett stadig flere tilfeller (og utbrudd), inkludert i Europa og USA. Ingrid, Jørgen og Nikolai snakker seg gjennom meslinger «fra tidenes morgen» og frem til i dag. Bli med på reisen!Og - for infeksjonsmedisinsk helsepersonell som lytter til episoden våren 2025 - her er lenke til påmelding NSCMID: Home - NSCMID 2025.Referanser:1. Roald Dahl, 1986: “Measles: A dangerous disease” (open letter to parents).2. Hübschen JM, et al. Measles. Lancet. 2022;399(10325):678-90.3. Berche P. History of measles. Presse Med. 2022;51(3):104149.4. Petrova VN, et al. Incomplete genetic reconstitution of B cell pools contributes to prolonged immunosuppression after measles. Sci Immunol. 2019;4(41).5. Mina MJ, et al. Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens. Science. 2019;366(6465):599-606.6. Belongia EA, Naleway AL. Smallpox vaccine: the good, the bad, and the ugly. Clin Med Res. 2003;1(2):87-92.8. Madsen KM, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002;347(19):1477-82.10.Holzmann H, et al. Eradication of measles: remaining challenges. Med Microbiol Immunol. 2016;205(3):201-8.11.Jafri SK, et al. Subacute sclerosing panencephalitis - current perspectives. Pediatric Health Med Ther. 2018;9:67-71.12. de Swart RL, et al. Rinderpest eradication: lessons for measles eradication? Curr Opin Virol. 2012;2(3):330-4.13.Kim TH, et al. Vaccine herd effect. Scand J Infect Dis. 2011;43(9):683-9.14.Doll MK, Correira JW. Revisiting the 2014-15 Disneyland measles outbreak and its influence on pediatric vaccinations. Hum Vaccin Immunother. 2021;17(11):4210-5.13.Nuwarda RF, et al. Vaccine Hesitancy: Contemporary Issues and Historical Background. Vaccines (Basel). 2022;10(10).16.Minta AA, Ferrari M, Antoni S, et al. Progress Toward Measles Elimination — Worldwide, 2000–2023. MMWR Morb Mortal Wkly Rep 2024;73:1036–1042.17.State School Immunization Requirements and Vaccine Exemption Laws, CDC 2022,State School Immunization Requirements and Vaccine Exemption Laws18.Epidemiologi meslinger UK og Europa: https://www.gov.uk/government/publications/measles-epidemiology-2023, European Region reports highest number of measles cases in more than 25 years – UNICEF, WHO/Europe Hosted on Acast. See acast.com/privacy for more information.
Episode 191: Diagnosis of ADHDFuture Dr. Granat explains how to diagnose Attention Deficit Hyperactivity Disorder. She explained the influence of social media in increasing awareness of ADHD. Dr. Arreaza added input about the validated tools for ADHD diagnosis and highlighted the importance of expert evaluation for the diagnosis of this disorder. Written by Yen Stephanie Granat, MSIV. Ross University School of Medicine. Comments and editing 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.Steph: I love podcasts—many of us do—and if you, like me, spend any amount of your leisure time listening to podcasts, perusing the news, or scrolling social media; you've likely noticed an alarming trend in the number of discussions we seem to be having about ADHD. It has grown into a very hot topic over the past couple of years, and for some of us, it seems to have even begun sneaking into our “recommended videos” and across our news feeds! Naturally, for the average person this can spur questions like:“Do I have ADHD? Do we all have it? How can I be certain either way, and what do I do if I find myself relating to most of the symptoms that I'm seeing discussed?”Granted that there is a whirlpool of information circulating around this hot topic, I was hoping to spend a bit of time clearly outlining the disorder for anyone finding themselves curious. I believe that can best be achieved through outlining a clear, concise, and easy-to-understand definition of what ADHD is; outlining what it is not; and helping people sift through the fact and the fiction. As with many important things we see discussed on the internet, we're seeing is that there is much more fiction than fact. Arreaza: I'm so glad you chose this topic! I think it is challenging to find reliable information about complex topics like ADHD. Tik Tok, Instagram and Facebook are great social media platforms, but we have to admit that fake news have spread like a fire in recent years. So, if you, listener, are looking for reliable information about ADHD, you are in the right place. With ADHD, there aren't any obvious indicators, or rapid tests someone can take at home to give themselves a reliable “yes” or “no” test result. People's concerns with ADHD are valid, and important to address, so we will discuss the steps to identify some of signs and symptoms they are seeing on TikTok or their favorite podcaster. Steph: Healthcare anxiety is a vital factor to consider when it comes to large cultural conversations around our minds and bodies; so, I hope to sweep away some of the misconceptions and misinformation floating around about ADHD. In doing so, I want to help alleviate any stress or confusion for anyone finding themselves wondering if ADHD is impacting their lives! We might even be able to more accurately navigate these kinds of “viral topics” (for lack of a better term) next time we see them popping up on our news feeds.Arreaza: The first thing I want to say about ADHD is “the crumpled paper sign.”Steph: What is that?Arreaza: It is an undescribed sign of ADHD, I have noticed it, and it is anecdotal, not evidence based. When I walk into a room to see a pediatric patient, I have noticed that when the paper that covers the examination table is crumpled, most of the times it is because the pediatric patient is very active. Then I proceed to ask questions about ADHD and I have been right many times about the diagnosis. So, just an anecdote, remember the crumpled paper sign. Steph: When you have patients coming to you asking for stimulants because they think they have ADHD, hopefully, after today, you can be better prepared to help those patients. So, for the average person—anyone wanting to be sure if this diagnosis applies to them—how can we really know?”Arreaza: So, let's talk about diagnosis.Steph: Yes, the clearest information we have is the DSM-5, which defines these disorders, as well as outlines the specific criteria (or “checkpoints”) one needs to meet to be able to have a formal diagnosis. However, this manual is best utilized by a trained professional—in this case, a physician—who can properly assess your signs and symptoms and give you a clear answer. Steph: ADHD stands for Attention Deficit Hyperactivity Disorder. It is among the most common neurodevelopmental disorders of childhood. That is not to say it does not affect adult—it does—and because it can be easy to miss, it's very possible for someone to have ADHD without knowing. Arreaza: I recently learned that ADD is an outdated term. Some people with ADHD do not have hyperactivity but the term still applies to them. Steph: Yes, there are multiple types that I will explain in just a bit. But overall the disorder is most simply characterized by a significant degree of difficulty in paying attention, controlling impulsive behaviors, or in being overly active in a way that the individual finds very difficult to control. (CDC)Arreaza: How common is ADHD?Steph: The most recently published data from The CDC estimates that 7 million (11.4%) of U.S. children between the ages of 3 and 17 have been diagnosed with ADHD. For adults, it is estimated that there are 15.5 million (6%) individuals in the U.S. who currently have ADHD. Arreaza: I suspected it would be more than that. [Anecdote about Boy Scout camp]. Steph: I totally agree. With short videos on TikTok, or paying high subscription fees to skip ads, it feels like as a society we all have a shorter attention span. Arreaza: Even churches are adapting to the new generation of believers: Shorter sermons and shorter lessons.Steph: When it comes to better understanding these numbers, it's also important to know that there are three distinct presentations of ADHD recognized by The CDC and The World Health Organization. Arreaza: The DSM-5 TR no longer uses the word “subtypes” for ADHD. Instead, it uses the word "presentation" to describe the different ways that ADHD may manifest in a person. That reminded me to update my old DSM-5 manual and I ordered it while reading today about ADHD. This means people with ADHD are no longer diagnosed as having a “subtype”. Instead, they are diagnosed with ADHD and a certain “presentation” of symptoms.Steph: These presentations are:Inattentive TypePeople often have difficulty planning or completing tasksThey find themselves easily distracted (especially when it comes to longer, focus-oriented tasks)They can often forget details and specifics, even with things that are part of their daily routineThis used to be referred to as “ADD” (you'll notice the absence of an “H”, segue).Hyperactive-Impulsive TypePeople often have a sense of intense “restlessness”, noticeable even in calm environments.They tend to be noticeably more talkative, and might often be seen interrupting others, or finishing their sentences.They find significant difficulty in being still for extended periods. Because of this, they are often unable to sit through a movie or class time, without fidgeting or getting up and moving around.With this category of ADHD, we often see an impulsiveness that unwittingly leads to risky behavior. Because of this, accidents and bodily injury are more common in individuals with this type of ADHD.Combined TypeThese are individuals who exhibit symptoms from both “Inattentive” and “Hyperactive-Impulsive” ADHD equally.Some listeners might have noticed that the categories are quite different, meaning that ADHD presents in different ways depending on the person! Two people who have ADHD can be in the same room and have vastly different presentations, whilst still having many of the same types of challenges. You also might have noticed what makes the discussion so interesting to the general public, which is also the thing that makes speaking to a professional to get formally tested so important:The diagnostic criteria rely heavily on patterns of behavior, or external variables; rather than on how a person might feel, or certain measurements taken from lab tests.Arreaza: Diagnosing ADHD requires evaluation by a professional who is properly trained for this. Fortunately, we have tools to assist with the diagnosis. The attention deficit must be noted in more than one major setting (e.g., social, academic, or occupational), that's why the information should be gathered from multiple sources, including parents, teachers, and other caregivers, using validated tools, such as:The Neuropsychiatric EEG-Based ADHD Assessment Aid (NEBA), recommended by the American Academy of NeurologyThe Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) and the Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS), recommended by the Society for Developmental and Behavioral Pediatrics.For adults: The validated rating scales include the Adult ADHD Self-Report Scale (ASRS) and the Conners Adult ADHD Rating Scales (CAARS).Steph: This is important because nearly everyone alive has experienced several, if not most, of these behavioral patterns at least once. Whether or not an individual has ADHD, I'm certain we could all think of moments we've had great difficulty focusing or sitting still. Perhaps some of us are incredibly forgetful, or act more impulsively than the average person might find typical. Getting a professional diagnosis is important because it is in skillfully assessing “the bigger picture” of a person's life, or their patterns of behavior, that a skilled physician, who understands the nuances and complexities in these disorders, can properly tell each of us whether we have ADHD, or not.Essentially, most of us could stand to use a bit more focus these days, but far fewer of us would meaningfully benefit from the kinds of treatments and therapies needed by individuals with ADHD to live healthier, more happy and regulated lives.Arreaza: I had a mother who came to discuss the results of the Vanderbilt Questionnaire. I think she left a little disappointed when she heard that, based on the responses from her and the teacher, her son did not have ADHD. Some kids may have behaviors such as being distracted during a meeting, forgetting about homework or having a lot of energy, but that does NOT mean necessarily that they have ADHD, right?Steph: Absolutely! The important thing to remember here is that these patterns of behavior outlined in the DSM-5 are merely an external gauge for a neurological reality. What the science is showing us is that the brains of people with ADHD are wired differently than that of the more “neurotypical” brain. Much like a check engine light would serve as a signal to a driver that something under the hood needs attention; these patterns of behavior, when they begin impeding our day to day lives, might tell us that it's time to see a professional (whether it be an auto mechanic or a trained physician). I think we all know someone who drives with their check engine light and not a care in the world. Arreaza: How serious/urgent is ADHD? Why should we care to make the diagnosis?Steph: Although we've yet to see anyone incur harm solely from having ADHD, it does lead to quite a range of more serious issues, some of which might prove more urgent. In the cases of ADHD, specifically, what we know is that there is a notable degree of dysregulation in some key neurotransmitters, like dopamine and norepinephrine. More plainly, what we are seeing in the brains of people with ADHD is a disruption, or alteration, of some of the brain's key chemicals.These neurotransmitters are largely responsible for much-needed processes like Motivation, Satisfaction, Focus, Impulse control, even things like energy and feelings of happiness. Many of these things serve as “fuel” for our day-to-day lives; things we'd call our “executive function”. These are also what prove dysfunctional in those struggling with ADHD. It is in this sense that we might be able to bridge a meaningful gap between ADHD as being seen through patterns of behaviorthat signal a real, neurological reality.Steph: We often hear of the brain referenced as a kind of supercomputer. A more accurate assessment might be that the brain is more of a network of interconnected computers that run different processes and require continual communication with one another for our brain to function properly and seamlessly. What we're seeing in members of the population with this diagnosis, is a significant disruption in these lines of communication. Although this is a very broad oversimplification, for the purposes of our metaphor is to think of it like our brain chemicals getting caught in a traffic jam, or parts of our brain attempting to communicate to one another with poor cell signal. Arreaza: Making the diagnosis is critical to start treatment because having that level of dysfunction sounds like having a very difficult life.Steph: Yeah! I think that's why this conversation matters so much. There's a sense of urgency there, because much of life is, in fact, boring. Things like paying bills, exercising and eating well, work and school—these are all things that are vital to health and wellbeing in day-to-day life; and for the more neurotypical brain, these things might prove occasionally challenging. Yet, they are still doable. For those with ADHD however, this goes far beyond mere boredom or “laziness” (which proves to be a trigger term for many—more on that in just a bit).For folks listening, I wanted to offer some statistics that show why this is such a big concern for the public, whether one has a formal ADHD diagnosis or not. The facts are figures are:Children with ADHD are more than five times as likely as the child without ADHD to have major depression.A significant increase in the prevalence of anxiety is seen in ADHD patients, ranging from 15% to 35%, when accounting for overlap in symptoms.There are significant correlations in youth diagnosed with ADHD, and those diagnosed with what are known as “externalizing disorders”. These are things like Conduct Disorder, Disruptive Mood Dysregulation Disorder, and Oppositional Defiant Disorder.We are seeing a much higher rate of academic problems in kids who have ADHD, like reading disorder, impaired verbal skills, and visual motor integration.We're finding that many, if not most, of these connections are being made after diagnosis. In the case of the “internalized disorders”, like depression and anxiety, we're often seeing years between ADHD diagnoses and the diagnoses of major depressive disorder or anxiety disorders. Given this framework, much of the data is theorized to point towards what we call “negative environmental circumstances”, otherwise known as “ADHD-related demoralization”.For children, this often looks like struggling with sitting still during class, failing to get homework done (because they forgot, or couldn't focus on the tasks at hand), and struggling to focus their attention on what their teacher is saying during lecture. These things often lead to bad grades, discipline or forced time sitting still in detention. This can be seen in more problems at home, with children being disciplined often for behavior that they struggle immensely to control.For adults, this can mean forgetting to pay your bills, missing work meetings, having trouble making appointments, or having difficulty with day-to-day tasks, really anything that requires sustained attention. We often see adults with ADHD who are chasing normalcy with caffeine addictions or even struggling with substance use. Arreaza: Substance use disorder actually can be a way for some people living with ADHD to self-treat their symptoms. Steph: These differences between the individual's experience and the world around them can lead to really powerful feelings of failure or inadequacy. They can affect your social life, your sense of community, and even further limit your capacity to seek help.Literacy in these things is so important—not just for the individual who feels that they may have ADHD, but also for those who are likely to encounter people with ADHD in their own lives. Understanding why some of these patterns pop up, even those who might not have a formal diagnosis, can go a long way to properly approaching these behaviors with success and with empathy.Arreaza: Learning about ADHD is fundamental for primary care doctors. We talked about the high prevalence and the influence of the media in increasing awareness and sometimes increasing public panic. So, we have to be prepared to diagnose or undiagnosed ADHD. Steph: Whether we're the physicians in the room, or the patient in the chair, I think it's important to have a clear understanding of what ADHD is and how it can affect lives. Thanks for listening, I hope we were able to teach you a little more about ADHD. ______________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:NICHQ-Vanderbilt-Assessment-Scales PDF: https://nichq.org/wp-content/uploads/2024/09/NICHQ-Vanderbilt-Assessment-Scales.pdfADHD: The facts. ADDA - Attention Deficit Disorder Association. (2023, January 11). https://add.org/adhd-facts/American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596.Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases. 2019 Sep 6;7(17):2420-2426. doi: 10.12998/wjcc.v7.i17.2420. PMID: 31559278; PMCID: PMC6745333.Staley BS, Robinson LR, Claussen AH, et al. Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment and Telehealth Use in Adults — National Center for Health Statistics Rapid Surveys System, United States, October – November 2023. CDC.Gov, MMWR Morb Mortal Wkly Rep 2024;73:890-895.Danielson ML, Claussen AH, Arifkhanova A, Gonzalez MG, Surman C. Who Provides Outpatient Clinical Care for Adults With ADHD? Analysis of Healthcare Claims by Types of Providers Among Private Insurance and Medicaid Enrollees, 2021. J Atten Disord. 2024 Jun;28(8):1225-1235. doi: 10.1177/10870547241238899. Epub 2024 Mar 18. PMID: 38500256; PMCID: PMC11108736. https://pubmed.ncbi.nlm.nih.gov/38500256/Mattingly G, Childress A. Clinical implications of attention-deficit/hyperactivity disorder in adults: what new data on diagnostic trends, treatment barriers, and telehealth utilization tell us. J Clin Psychiatry. 2024;85(4):24com15592. https://www.psychiatrist.com/jcp/implications-adult-adhd-diagnostic-trends-treatment-barriers-telehealth/Didier J. My four kids and I all have ADHD. We need telehealth options. STAT News. Published October 10, 2024. Accessed October 10, 2024. https://www.statnews.com/2024/10/10/adhd-medication-shortage-telehealth-dea-congress/.Hong J, Mattingly GW, Carbray JA, Cooper TV, Findling RL, Gignac M, Glaser PE, Lopez FA, Maletic V, McIntyre RS, Robb AS, Singh MK, Stein MA, Stahl SM. Expert consensus statement for telepsychiatry and attention-deficit hyperactivity disorder. CNS Spectr. 2024 May 20:1-12. doi: 10.1017/S1092852924000208. Epub ahead of print. PMID: 38764385. https://pubmed.ncbi.nlm.nih.gov/38764385/Gabor Maté: The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. (2022). Youtube. Retrieved April 27, 2025, from https://www.youtube.com/watch?v=ttu21ViNiC0. Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
Tetanus has probably been around for most of human history, or even longer. But it’s preventable today thanks to vaccines. Research: "Emil von Behring." Notable Scientists from 1900 to the Present, edited by Brigham Narins, Gale, 2008. Gale In Context: Science, link.gale.com/apps/doc/K1619001490/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=464250e5. Accessed 17 Apr. 2025. Breasted, J.H., translator. “OIP 3. The Edwin Smith Surgical Papyrus, Volume 1: Hieroglyphic Transliteration, Translation, and Commentary.” Oxford University Press. 1930. Chalian, William. “An Essay on the History of Lockjaw.” Bulletin of the History of Medicine, FEBRUARY, 1940, Vol. 8, No. 2. Via JSTOR. https://www.jstor.org/stable/44446242 Emil von Behring: The founder of serum therapy. NobelPrize.org. Nobel Prize Outreach 2025. Thu. 17 Apr 2025. https://www.nobelprize.org/prizes/medicine/1901/behring/article/ Galassi, Francesco Maria et al. “Tetanus: historical and palaeopathological aspects considering its current health impact.” Journal of preventive medicine and hygiene vol. 65,4 E580-E585. 31 Jan. 2025, doi:10.15167/2421-4248/jpmh2024.65.4.3376 George, Elizabeth K. “Tetanus (Clostridium tetani Infection).” StatPearls. January 2025. https://www.ncbi.nlm.nih.gov/books/NBK482484/ Hippocrates. “VI. Diseases, Internal Affections.” Harvard University Press. 1988. Jean-Marc Cavaillon, Historical links between toxinology and immunology, Pathogens and Disease, Volume 76, Issue 3, April 2018, fty019, https://doi.org/10.1093/femspd/fty019 Jones CE, Yusuf N, Ahmed B, Kassogue M, Wasley A, Kanu FA. Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination — Worldwide, 2000–2022. MMWR Morb Mortal Wkly Rep 2024;73:614–621. DOI: http://dx.doi.org/10.15585/mmwr.mm7328a1 Kaufmann, Stefan H E. “Remembering Emil von Behring: from Tetanus Treatment to Antibody Cooperation with Phagocytes.” mBio vol. 8,1 e00117-17. 28 Feb. 2017, doi:10.1128/mBio.00117-17 Kreston, Rebecca. “Tetanus, the Grinning Death.” Discover. 9/29/2015. https://www.discovermagazine.com/health/tetanus-the-grinning-death Milto, Lori De, and Leslie Mertz, PhD. "Tetanus." The Gale Encyclopedia of Public Health, edited by Brigham Narins, 2nd ed., vol. 2, Gale, 2020, pp. 1074-1076. Gale In Context: Environmental Studies, link.gale.com/apps/doc/CX7947900274/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=a44bc544. Accessed 14 Apr. 2025. Milto, Lori De, and Leslie Mertz, PhD. "Tetanus." The Gale Encyclopedia of Public Health, edited by Brigham Narins, 2nd ed., vol. 2, Gale, 2020, pp. 1074-1076. Gale In Context: Environmental Studies, link.gale.com/apps/doc/CX7947900274/GPS?u=mlin_n_melpub&sid=bookmark-GPS&xid=a44bc544. Accessed 15 Apr. 2025. National Institutes of Health. “Tetanus.” https://history.nih.gov/display/history/Tetanus Ni, Maoshing. “The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary.” Shambhala. 1995. Smithsonian. “The Antibody Initiative: Battling Tetanus.” https://www.si.edu/spotlight/antibody-initiative/battling-tetanus Sundwall, John. “Man and Microbes.” Illustrated lecture given under the auspices of the Kansas Academy of Science, Topeka, January 12, 1917. https://archive.org/details/jstor-3624335/ The Nobel Prize in Physiology or Medicine 1901. NobelPrize.org. Nobel Prize Outreach 2025. Thu. 17 Apr 2025. https://www.nobelprize.org/prizes/medicine/1901/summary/ Tiwari, Tejpratap S.P. et al. “Chapter 21: Tetanus.” CDC Pink Book. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-21-tetanus.html Von Behring, Emil and Kitasato Shibasaburo. “The Mechanism of Immunity in Animals to Diphtheria and Tetanus.” Immunology. 1890. http://raolab.org/upfile/file/20200612164743_201234_56288.pdf War Office Committee for the Study of Tetanus. “Memorandum on Tetanus.” Fourth Edition. 1919. https://archive.org/details/b32171201/ World Health Organization. “Tetanus.” 7/12/2024. https://www.who.int/news-room/fact-sheets/detail/tetanus See omnystudio.com/listener for privacy information.
Diarrhea is one of the more common concerns in emergency medicine worldwide and in the United States, yet we often do not spend enough time understanding the breadth of causes and considerations for this syndrome. Do you know which patients benefit from Zinc? Would you like to review HUS? Can you mixup Oral Rehydration Solution if you needed to? We cover all of this and more in this “code brown” of a chapter! So come, get dirty with Alex and Venk in this truly crappy chapter of Always on EM! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80. doi: 10.1093/cid/cix669. PMID: 29053792; PMCID: PMC5850553. Gore JI, Surawicz C. Severe acute diarrhea. Gastroenterol Clin North Am. 2003 Dec;32(4):1249-67. doi: 10.1016/s0889-8553(03)00100-6. PMID: 14696306; PMCID: PMC7127018. Freedman SB, van de Kar NCAJ, Tarr PI. Shiga Toxin–Producing Escherichia coli and the Hemolytic–Uremic Syndrome. The New England Journal of Medicine. 2023;389(15):1402-1414. doi:10.1056/NEJMra2108739. Logan C, Beadsworth MB, Beeching NJ. HIV and diarrhoea: what is new? Curr Opin Infect Dis. 2016 Oct;29(5):486-94. doi: 10.1097/QCO.0000000000000305. PMID: 27472290. Chassany O, Michaux A, Bergmann JF. Drug-induced diarrhoea. Drug Saf. 2000 Jan;22(1):53-72. doi: 10.2165/00002018-200022010-00005. PMID: 10647976. Schiller LR. Secretory diarrhea. Curr Gastroenterol Rep. 1999 Oct;1(5):389-97. doi: 10.1007/s11894-999-0020-8. PMID: 10980977. Gong Z, Wang Y. Immune Checkpoint Inhibitor-Mediated Diarrhea and Colitis: A Clinical Review. JCO Oncol Pract. 2020 Aug;16(8):453-461. doi: 10.1200/OP.20.00002. Epub 2020 Jun 25. PMID: 32584703. Do C, Evans GJ, DeAguero J, Escobar GP, Lin HC, Wagner B. Dysnatremia in Gastrointestinal Disorders. Front Med (Lausanne). 2022 May 13;9:892265. doi: 10.3389/fmed.2022.892265. PMID: 35646996; PMCID: PMC9136014. Expert Panel on Gastrointestinal Imaging; Chang KJ, Marin D, Kim DH, Fowler KJ, Camacho MA, Cash BD, Garcia EM, Hatten BW, Kambadakone AR, Levy AD, Liu PS, Moreno C, Peterson CM, Pietryga JA, Siegel A, Weinstein S, Carucci LR. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol. 2020 May;17(5S):S305-S314. doi: 10.1016/j.jacr.2020.01.025. PMID: 32370974. Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017 Jun;19(6):28. doi: 10.1007/s11894-017-0566-9. PMID: 28439845. Modahl L, Digumarthy SR, Rhea JT, Conn AK, Saini S, Lee SI. Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization. J Am Coll Radiol. 2006 Nov;3(11):860-6. doi: 10.1016/j.jacr.2006.05.011. PMID: 17412185. Scheirey CD, Fowler KJ, Therrien JA, et al. ACR Appropriateness Criteria Acute Nonlocalized Abdominal Pain. Journal of the American College of Radiology : JACR. 2018;15(11S):S217-S231. doi:10.1016/j.jacr.2018.09.010. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol. 2009 Oct;104(10):2596-604; quiz 2605. doi: 10.1038/ajg.2009.329. Epub 2009 Jun 23. PMID: 19550407. Musekiwa A, Volmink J. Oral rehydration salt solution for treating cholera: ≤ 270 mOsm/L solutions vs ≥ 310 mOsm/L solutions. Cochrane Database Syst Rev. 2011 Dec 7;2011(12):CD003754. doi: 10.1002/14651858.CD003754.pub3. PMID: 22161381; PMCID: PMC6532622. Centers for Disease Control and Prevention (CDC). Scombroid fish poisoning associated with tuna steaks--Louisiana and Tennessee, 2006. MMWR Morb Mortal Wkly Rep. 2007 Aug 17;56(32):817-9. PMID: 17703171. Résière D, Florentin J, Mehdaoui H, Mahi Z, Gueye P, Hommel D, Pujo J, NKontcho F, Portecop P, Nevière R, Kallel H, Mégarbane B. Clinical Characteristics of Ciguatera Poisoning in Martinique, French West Indies-A Case Series. Toxins (Basel). 2022 Aug 3;14(8):535. doi: 10.3390/toxins14080535. PMID: 36006197; PMCID: PMC9415704. Centers for Disease Control and Prevention (CDC). Ciguatera fish poisoning--Texas, 1998, and South Carolina, 2004. MMWR Morb Mortal Wkly Rep. 2006 Sep 1;55(34):935-7. PMID: 16943762. Thyroid Inferno EM Blog: https://emblog.mayo.edu/2014/11/01/thyroid-inferno/ Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016 Dec 20;12(12):CD005436. doi: 10.1002/14651858.CD005436.pub5. PMID: 27996088; PMCID: PMC5450879. Dhingra U, Kisenge R, Sudfeld CR, Dhingra P, Somji S, Dutta A, Bakari M, Deb S, Devi P, Liu E, Chauhan A, Kumar J, Semwal OP, Aboud S, Bahl R, Ashorn P, Simon J, Duggan CP, Sazawal S, Manji K. Lower-Dose Zinc for Childhood Diarrhea - A Randomized, Multicenter Trial. N Engl J Med. 2020 Sep 24;383(13):1231-1241. doi: 10.1056/NEJMoa1915905. PMID: 32966722; PMCID: PMC7466932. Dalfa RA, El Aish KIA, El Raai M, El Gazaly N, Shatat A. Oral zinc supplementation for children with acute diarrhoea: a quasi-experimental study. Lancet. 2018 Feb 21;391 Suppl 2:S36. doi: 10.1016/S0140-6736(18)30402-1. Epub 2018 Feb 21. PMID: 29553435. 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
Episode 188: RSV Management and PreventionDr. Sandhu and future Dr. Mohamed summarize the management of RSV and describe how to prevent it with chemoprophylaxis and vaccines. Dr Arreaza adds some comments about RSV vaccines.Written by Abdolhakim Mohamed, MSIV, Ross University School of Medicine. Comments by Ranbir Sandhu, MD, and 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 RSV? -The Respiratory syncytial Virus (RSV) is an enveloped, negative-sense, single-stranded RNA virus of the Orthopneumovirus genus within the Pneumoviridae family. -RSV is a major cause of acute respiratory tract infections, particularly bronchiolitis and pneumonia, in infants and young children, and it also significantly affects older adults and immunocompromised individuals. -RSV infections cause an estimated 58,000–80,000 hospitalizations among children younger than 5 years and 60,000–160,000 hospitalizations among adults older than 65 years each year.-RSV is highly contagious and spreads through respiratory droplets and direct contact with contaminated surfaces. The virus typically causes seasonal epidemics, peaking in the winter months in temperate climates and during the rainy season in tropical regions. -Virtually all children are infected with RSV by the age of two, and reinfections can occur throughout life, often with milder symptoms.-Per the 2014 Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis, from the American Academy of Pediatrics, the most common etiology of bronchiolitis is RSV. -About 97% of children are infected with RSV in the first 2 years of life, about 40% will experience lower respiratory tract infection during the initial infection. Other viruses that cause bronchiolitis include human rhinovirus, human metapneumovirus, influenza, adenovirus, coronavirus, and parainfluenza viruses.When is RSV season?-Classically, the highest incidence of infection occurs between December and March in North America. Per CDC, there were typical prepandemic RSV season patterns, but the COVID-19 pandemic disrupted RSV seasonality during 2020–2022. -Before we dive into the seasonality patterns, for context, in order to describe RSV seasonality in the US, data was gathered and analyzed from polymerase chain reaction (PCR) test results reported to the National Respiratory and Enteric Virus Surveillance System (NREVSS) during July 2017–February 2023. -Seasonal RSV epidemics were defined as the weeks during which the percentage of PCR test results that were positive for RSV was ≥3%. Per 2017–2020 data, RSV epidemics in the United States typically follow seasonal patterns, that began in October, peaked in December or January, and ended in April. -However, during 2020–21, the typical winter RSV epidemic did not occur. The 2021–22 season began in May, peaked in July, and ended in January. -The 2022–23 season started (June) and peaked (November) later than the 2021–22 season, but earlier than prepandemic seasons. CDC notes that the timing of the 2022–23 season suggests that seasonal patterns are returning toward those observed in prepandemic years, however, warn that clinicians should be aware that off-season RSV circulation might continue.Treatment of RSVSome key points of the 2014 pediatric guidelines from the American Academy of Pediatrics.-AAP strongly do not recommend beta agonists or steroids for viral associated bronchiolitis because of no significant improved outcomes. “Clinicians should not administer albuterol (or salbutamol) to infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).”-Epinephrine is not recommended for infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).-Nebulized hypertonic saline should not be administered to infants with a diagnosis of bronchiolitis in the emergency department (Evidence Quality: B; Recommendation Strength: Moderate Recommendation), but hypertonic saline may be administered when they are hospitalized (Evidence Quality: B; Recommendation Strength: Weak Recommendation [based on randomized controlled trials with inconsistent findings]).-Chest physiotherapy should not be used in infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Moderate Recommendation).-Antibiotics should not be administered in bronchiolitis unless there is a concomitant bacterial infection, or a strong suspicion of one (Evidence Quality: B; Recommendation Strength: Strong Recommendation).-Oxygen therapy may not be administered if the oxyhemoglobin saturation exceeds 90% in infants and children with a diagnosis of bronchiolitis (Evidence Quality: D; Recommendation Strength: Weak Recommendation [based on low level evidence and reasoning from first principles]).-Clinicians should administer nasogastric or intravenous fluids for infants with a diagnosis of bronchiolitis who cannot maintain hydration orally (Evidence Quality: X; Recommendation Strength: Strong Recommendation).How do we prevent RSV?Infant Immuno-prophylaxis:A clinical trial in 2022 demonstrated that a single injection of nirsevimab (Beyfortus®), administered before the RSV season, protected healthy late-preterm and term infants from RSV-associated lower respiratory tract that required medical treatment. Nirsevimab is a monoclonal antibody to the RSV fusion protein that has an extended half-life.Additionally, on August 3, 2023, the Advisory Committee on Immunization Practices (ACIP) recommended nirsevimab for all infants younger than 8 months who are born during or entering their first RSV season and for infants and children between 8-19 months who are at increased risk for severe RSV disease and are entering their second RSV season. On the basis of pre-COVID-19 pandemic patterns, nirsevimab could be administered in most of the continental United States from October through the end of March.Maternal Vaccination: The CDC recommends the administration of the RSVPreF vaccine to pregnant women between 32 0/7 and 36 6/7 weeks of gestation. This vaccination aims to reduce the risk of RSV-associated lower respiratory tract infection in infants during the first 6 months of life.At this time, if a pregnant woman has already received a maternal RSV vaccine during any previous pregnancy, CDC does not recommend another dose of RSV vaccine during subsequent pregnancies.Older individuals: -Each year in the U.S., it is estimated that between 60,000 and 160,000 older adults are hospitalized and between 6,000 and 10,000 die due to RSV infection-ABRYSVO's approval will help offer older adults protection in the RSV season.-On June 26, 2024, ACIP voted to give these recommendations: all adults older than 75 years and adults between 60–74 years who are at increased risk for severe RSV disease should receive a single dose of RSV vaccine (Abrysvo®).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:Hamid S, Winn A, Parikh R, et al. Seasonality of Respiratory Syncytial Virus — United States, 2017–2023. MMWR Morb Mortal Wkly Rep 2023;72:355–361. DOI: http://dx.doi.org/10.15585/mmwr.mm7214a1Hammitt LL, Dagan R, Yuan Y, Baca Cots M, Bosheva M, Madhi SA, Muller WJ, Zar HJ, Brooks D, Grenham A, Wählby Hamrén U, Mankad VS, Ren P, Takas T, Abram ME, Leach A, Griffin MP, Villafana T; MELODY Study Group. Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants. N Engl J Med. 2022 Mar 3;386(9):837-846. doi: 10.1056/NEJMoa2110275. PMID: 35235726.Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S 3rd, Hernandez-Cancio S; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502. doi: 10.1542/peds.2014-2742. Erratum in: Pediatrics. 2015 Oct;136(4):782. doi: 10.1542/peds.2015-2862. PMID: 25349312.CDC, per their published article Seasonality of Respiratory Syncytial Virus — United States for 2017–2023, in the United StatesWhat U.S. Obstetricians Need to Know About Respiratory Syncytial Virus.Debessai H, Jones JM, Meaney-Delman D, Rasmussen SA. Obstetrics and Gynecology. 2024;143(3):e54-e62. doi:10.1097/AOG.0000000000005492.Maternal Respiratory Syncytial Virus Vaccination and Receipt of Respiratory Syncytial Virus Antibody (Nirsevimab) by Infants Aged
Host: Matt Birnholz, MD Guest: Jennifer L. Payne, MD Guest: Melissa Simon, MD Postpartum depression is a serious medical condition that is among the most common complications during and after pregnancy; however, it is often underdiagnosed.1-4 To learn more about screening patients for postpartum depression, Dr. Matt Birnholz speaks with Dr. Jennifer Payne and Dr. Melissa Simon about screening strategies, the impact of health inequities, and the latest medical guidelines regarding the importance of early screening for postpartum depression. Dr. Payne is a Professor of Psychiatry and Neurobehavioral Sciences as well as Obstetrics and Gynecology at the University of Virginia, and Dr. Simon is a Professor of Obstetrics and Gynecology at the Northwestern University Feinberg School of Medicine. References American Psychiatric Association. Depressive disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5™. 5th ed. American Psychiatric Publishing; 2013:155-188. Bauman BL, Ko JY, Cox S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581. Cox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN. The Perinatal Depression Treatment Cascade: Baby Steps Toward Improving Outcomes. J Clin Psychiatry. 2016;77(9):1189-1200. Thompson KS, Fox JE. Post-partum depression: a comprehensive approach to evaluation and treatment. Ment Health Fam Med. 2010;7(4):249-257. …
Host: Matt Birnholz, MD Guest: Jennifer L. Payne, MD Guest: Melissa Simon, MD Postpartum depression is a serious medical condition that is among the most common complications during and after pregnancy; however, it is often underdiagnosed.1-4 To learn more about screening patients for postpartum depression, Dr. Matt Birnholz speaks with Dr. Jennifer Payne and Dr. Melissa Simon about screening strategies, the impact of health inequities, and the latest medical guidelines regarding the importance of early screening for postpartum depression. Dr. Payne is a Professor of Psychiatry and Neurobehavioral Sciences as well as Obstetrics and Gynecology at the University of Virginia, and Dr. Simon is a Professor of Obstetrics and Gynecology at the Northwestern University Feinberg School of Medicine. References American Psychiatric Association. Depressive disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5™. 5th ed. American Psychiatric Publishing; 2013:155-188. Bauman BL, Ko JY, Cox S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581. Cox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN. The Perinatal Depression Treatment Cascade: Baby Steps Toward Improving Outcomes. J Clin Psychiatry. 2016;77(9):1189-1200. Thompson KS, Fox JE. Post-partum depression: a comprehensive approach to evaluation and treatment. Ment Health Fam Med. 2010;7(4):249-257. …
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-390 Overview: In 1995, the US launched a varicella vaccination program, leading to a significant drop in cases. However, breakthrough infections still occur, and clinical diagnosis has become less reliable as the virus has evolved. Join us to hear current recommendations for what to consider in the differential diagnosis and how emerging evidence may impact public health and your practice. Episode resource links: Marin, M, Leung, J, Anderson, TC, Lopez, AS. Monitoring Varicella Vaccine Impact on Varicella Incidence in the United States: Surveillance Challenges and Changing Epidemiology, 1995–2019, The Journal of Infectious Diseases, Volume 226, Issue Supplement_4, 1 November 2022, Pages S392–S399, https://doi.org/10.1093/infdis/jiac221 Qiu L, Liu S, Zhang M, et al. The epidemiology of varicella and effectiveness of varicella vaccine in Ganyu, China: a long-term community surveillance study. BMC Public Health. 2023;23(1):1875. Published 2023 Sep 28. doi:10.1186/s12889-023-16304-4 Ruprecht A, Marin M, Strain AK, Harry K, Kenyon C. Notes from the Field: Expanded Laboratory Testing for Varicella — Minnesota, 2016–2023. MMWR Morb Mortal Wkly Rep 2024;73:245–246. DOI: http://dx.doi.org/10.15585/mmwr.mm7311a3 DynaMed – Chicken pox – Varicella (https://www-dynamed-com.umassmed.idm.oclc.org/condition/chickenpox#GUID-DFBFAA99-31E8-4553-AFDB-AA1988B1967A): Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-390 Overview: In 1995, the US launched a varicella vaccination program, leading to a significant drop in cases. However, breakthrough infections still occur, and clinical diagnosis has become less reliable as the virus has evolved. Join us to hear current recommendations for what to consider in the differential diagnosis and how emerging evidence may impact public health and your practice. Episode resource links: Marin, M, Leung, J, Anderson, TC, Lopez, AS. Monitoring Varicella Vaccine Impact on Varicella Incidence in the United States: Surveillance Challenges and Changing Epidemiology, 1995–2019, The Journal of Infectious Diseases, Volume 226, Issue Supplement_4, 1 November 2022, Pages S392–S399, https://doi.org/10.1093/infdis/jiac221 Qiu L, Liu S, Zhang M, et al. The epidemiology of varicella and effectiveness of varicella vaccine in Ganyu, China: a long-term community surveillance study. BMC Public Health. 2023;23(1):1875. Published 2023 Sep 28. doi:10.1186/s12889-023-16304-4 Ruprecht A, Marin M, Strain AK, Harry K, Kenyon C. Notes from the Field: Expanded Laboratory Testing for Varicella — Minnesota, 2016–2023. MMWR Morb Mortal Wkly Rep 2024;73:245–246. DOI: http://dx.doi.org/10.15585/mmwr.mm7311a3 DynaMed – Chicken pox – Varicella (https://www-dynamed-com.umassmed.idm.oclc.org/condition/chickenpox#GUID-DFBFAA99-31E8-4553-AFDB-AA1988B1967A): Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-353 Overview: Bronchiolitis caused by respiratory syncytial virus (RSV) infection in infants is common and can lead to hospitalization if severe. There are now 2 ways to prevent this: immunizing the mother during pregnancy or giving monoclonal antibodies. Listen in as we discuss the recommendations for RSV prevention and how to best incorporate them into your practice. Episode resource links: Fleming-Dutra KE, Jones JM, Roper LE, et al. Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus–Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1115–1122. Jones JM, Fleming-Dutra KE, Prill MM, et al. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep 2023;72:920–925 Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. Guest: Alan M. Ehrlich MD, FAAFP Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-353 Overview: Bronchiolitis caused by respiratory syncytial virus (RSV) infection in infants is common and can lead to hospitalization if severe. There are now 2 ways to prevent this: immunizing the mother during pregnancy or giving monoclonal antibodies. Listen in as we discuss the recommendations for RSV prevention and how to best incorporate them into your practice. Episode resource links: Fleming-Dutra KE, Jones JM, Roper LE, et al. Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus–Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1115–1122. Jones JM, Fleming-Dutra KE, Prill MM, et al. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep 2023;72:920–925 Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. Guest: Alan M. Ehrlich MD, FAAFP Music Credit: Richard Onorato
Show Notes for Episode 27 of “The 2 View” – Brain abscesses, torsion, and delirium. Brain Abscesses Accorsi EK, Hall M, Hersh AL, Shah SS, Schrag SJ, Cohen AL. Notes from the Field: Update on Pediatric Intracranial Infections - 19 States and the District of Columbia, January 2016-March 2023. MMWR Morb Mortal Wkly Rep. CDC, Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7222a5.htm Brook I. Clinical Case. Brain Abscess Clinical Presentation. Medscape.com. https://reference.medscape.com/article/212946-clinical Goodman B. Doctors watching for more cases after mysterious cluster of brain infections strikes kids in southern Nevada. CNN. CNN Health. https://www.cnn.com/2023/04/28/health/brain-abscess-cluster-nevada/index.html The Center for Medical Education. 23 - Dear Doctor, Skin Closures, and Wound Management. 2 View: Emergency Medicine PAs & NPs. https://2view.fireside.fm/23 What's “ordinary negligence”? //Missed brain abscess//Special offer. Mad Mimi. Medical Malpractice Insights: Learning from Lawsuits. https://madmimi.com/s/3fc5711 Testicular Torsion Lukosiute-Urboniene A, Nekrosius D, Dekeryte I, Kilda A, Malcius D. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. BMJ Journals. https://emj.bmj.com/content/40/2/134.info Mellick LB, Watters BC. The Torsed Testicle Traction Technique and 2 Case Reports. Pediatr Emerg Care. https://journals.lww.com/pec-online/Citation/2023/05000/TheTorsedTesticleTractionTechniqueand2_Case.14.aspx Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion: direction, degree, duration and disinformation. J Urol. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/12544339/ Ovarian Torsion Long B, Koyfman A, Gottlieb M. Dispelling 5 Ovarian Torsion Myths. ACEP Now. https://www.acepnow.com/article/dispelling-5-ovarian-torsion-myths/ Ovarian Torsion. Acep.org. ACEP Emergency Ultrasound Section. https://www.acep.org/emultrasound/newsroom/sept2020/ovarian-torsion Spinelli C, Piscioneri J, Strambi S. Adnexal Torsion in Adolescents: Update and review of the literature. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/08/adnexal-torsion-in-adolescents Swenson DW, Lourenco AP, Beaudoin FL, Grand DJ, Killelea AG, McGregor AJ. Ovarian torsion: Case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. European Journal of Radiology. ScienceDirect. https://edus.ucsf.edu/sites/edus.ucsf.edu/files/wysiwyg/1-s2.0-S0720048X14000023-main.pdf Delirium ACEP's Position on Hyperactive Delirium. American College of Emergency Physicians. https://www.acep.org/news/acep-newsroom-articles/aceps-position-on-hyperactive-delirium Hatten BW, Bonney C, Dunne RB, et al. ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings, Approved by the ACEP Board of Directors, June 23, 202. American College of Emergency Physicians. https://www.acep.org/siteassets/new-pdfs/education/acep-task-force-report-on-hyperactive-delirium-final.pdf Hayes BD, O'Brien M. Should Diphenhydramine be included in an Acute Agitation Regimen? AliEM: Academic Life in Emergency Meedicine. https://www.aliem.com/diphenhydramine-acute-agitation-regimen/ Psychiatric Patient. American College of Emergency Physicians. https://www.acep.org/patient-care/clinical-policies/Psychiatric-Patient Reuben. Emergency Department Agitated Patient Treatment Map. Emergency Medicine Updates. https://emupdates.com/danger/ Veraart JKE, Smith-Apeldoorn SY, Bakker IM, et al. Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review. Int J Neuropsychopharmacol. Oxford Academic. https://academic.oup.com/ijnp/article/24/10/808/6309481?login=false Prescription Drug Monitoring Programs D'Souza RS, Lang M, Eldrige JS. Prescription Drug Monitoring Program. StatPearls Publishing. NIH: National Library of Medicine. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK532299/ Something Sweet Brito C. Bobi, the world's oldest dog, turns 31 years old. CBS News. https://www.cbsnews.com/news/bobi-the-worlds-oldest-dog-turns-31-years-old/ Recurring Sources Center for Medical Education. http://ccme.org The Proceduralist. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com
Lauren and JJ discuss a new monoclonal antibody treatment for parvoviral enteritis, review a case of bat-transmitted rabies in a human child, and share their favorite things of the week. Sources: * Seymour KG. Elanco announces first-ever canine parvovirus treatment. AAHA NEWStat. May 5, 2023. https://www.aaha.org/publications/newstat/articles/2023-5/elanco-announces-first-ever-canine-parvovirus-treatment/#:~:text=What%20to%20know%20about%20CPMA,weeks%20old%20who%20test%20positive * Elanco announces breakthrough treatment for deadly canine parvovirus. Elanco. May 2, 2023. https://www.elanco.com/en-us/insights/elanco-announces-breakthrough-treatment-for-deadly-canine-parvovirus * Blackburn D, Minhaj FS, Al Hammoud R, et al. Human Rabies — Texas, 2021. MMWR Morb Mortal Wkly Rep 2022;71:1547–1549. DOI: http://dx.doi.org/10.15585/mmwr.mm7149a2 * Hein I. CDC detais rabies death after boy goes untreated following bat bite. Medpage Today. December 9, 2022. https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/102181
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, and episodes originally aired from 2016 to 2021. Originally released: September 13, 2018 In 2012, more than 13,000 Americans were inadvertently exposed to contaminated medical equipment, resulting in one of the largest fungal outbreaks in United States history. Despite rapid mobilization by the CDC and FDA, 751 patients died from complications of fungal brain infections. But this is more the exception than the rule when it comes to fungal infections of the central nervous system. This week on the BrainWaves podcast, we review the common (and uncommon) clinical, radiographic, and diagnostic features of fungal brain disease. Enjoy! Produced by James E Siegler. Music by Jahzzar, Swelling, The Insider, and Chris Zabriskie. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Baddley JW, Salzman D, Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Transplant 2002;16(6):419-24. PMID 12437621 Benedict K, Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis 2014;20(3):349-55. PMID 24565446 Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D. Brain abscess. N Engl J Med 2014;371(5):447-56. PMID 25075836 Kainer MA, Reagan DR, Nguyen DB, et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med 2012;367(23):2194-203. PMID 23131029 McCotter OZ, Smith RM, Westercamp M, et al. Update on multistate outbreak of fungal infections associated with contaminated methylprednisolone injections, 2012-2014. MMWR Morb Mortal Wkly Rep 2015;64(42):1200-1. PMID 26513534 Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol 2018;17(4):362-72. PMID 29477506 Smith RM, Schaefer MK, Kainer MA, et al. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med 2013;369(17):1598-609. PMID 23252499 Wilson MR, O'Donovan BD, Gelfand Jmet al. Chronic meningitis investigated via metagenomic next-generation sequencing. JAMA Neurol 2018;75(8):947-55. PMID 29710329 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.
In this episode host Lauren Walker, Program Director for the Hep C and Drug User Health Center of Excellence at CEI, speaks with special guests Dr. Sharon Stancliff and NYSDOH's Lisa Skill about the increasing health threat posed by Xylazine. Dr. Stancliff is Associate Medical Director of Harm Reduction in Healthcare and Medical Director of Harm Reduction in Healthcare, AIDS Institute, NYSDOH. She has been working with people who use drugs since 1990, and currently focuses on opioid overdose prevention. Lisa Skill is a Health Program Coordinator at the NYSDOH AIDS Institute Office of Drug User Health. Xylazine, often called “tranq” or “tranq dope” on the street, is being used to amplify and extend the effects of other drugs such as stimulants, opioids, and other sedatives. The drug was designed for veterinary use in animals as a sedative and muscle relaxant and is not approved for human consumption. Human use of Xylazine was first noted in Puerto Rico in the early 2000s, and has since spread across the U.S. into local drug supplies. In November 2022, the FDA issued a national warning to healthcare professionals to be cautious of the potential for xylazine inclusion in fentanyl, heroin and other illicit drug overdoses. This episode will describe xylazine trends and use over time, and provide clinicians with an understanding of the physiologic effects of xylazine intoxication. Dr. Sharon Stancliff and Lisa Skill will also share their clinical and harm reduction recommendations for xylazine intoxication, overdose and withdrawal. Related Content: NYSDOH Naloxone Availability without a prescription Safer Consumption Spaces - End Overdose NY Fiorentin TR, Logan BK. Analytical findings in used syringes from a syringe exchange program. Int J Drug Policy. 2022, 81:102770. doi: 10.1016/j.drugpo.2020.102770 Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, Shover C. Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022, 233:109380. doi: 10.1016/j.drugalcdep.2022.109380 Johnson J, Pizzicato L, Johnson C, Viner K. Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010-2019. Injury Prevention. 2021, 24:395-398. doi: 10.1136/injuryprev-2020-043968 Kariisa M, Patel P, Smith H, Bitting J. Notes from the field: Xylazine detection and involvement in drug overdose deaths – United States, 2019. MMWR Morb Mortal Wkly Rep. 2021, 70(37):1300-1302. doi: 10.15585/mmwr.mm7037a4 National Institute of Drug Abuse. Xylazine. Ruiz-Colón K, Chavez-Arias C, Díaz-Alcalá JE, Martínez MA. Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature. Forensic Sci Int. 2014, 240:1-8. doi: 10.1016/j.forsciint.2014.03.015 United States Department of Justice, Drug Enforcement Administration. Xylazine. November 2022. United States Food and Drug Administration. FDA alerts health care professionals of risks to patients exposed to xylazine in illicit drugs. November 2022. CEI toll free line for NYS providers: 866-637-2342 https://ceitraining.org/
BREAKING NEWS: The 2022 CDC Opioid Guideline Update is published!!! Unless you'd like to read all 100 pages of the guideline publication on your own, you may want to start by listening to this episode at least once. Join the Mark “Pain Guy” Garofoli on the Pain Pod for a dynamic dissection of the 2022 CDC Opioid Guideline Update. Not a ton of actual updates compared to the 2016 guideline, but a half dozen that every clinician needs to be aware of, along with a handful a very specific reference checks leading to rather riveting conversations in the near future for you. “Pain Guy” will review all aspects of this incredibly important advancement in pain management so that you can correlate to your own patient care, educational efforts, or whatever setting you're in NOW. You may want to listen to this episode twice, and share it will everyone (seriously, all clinicians need to listen in, and patients in pain alike)!!! Come one, come all, to the Pain Pod!!! 2022 CDC Opioid Guideline Revision Resources 2022 CDC Opioid Guideline Update: CDC Chronic Pain Opioid Guidelines: MMWR March 2016. http://dx.doi.org/10.15585/mmwr.rr7103a1 CDC Opioid Guideline Update Timeline: https://www.cdc.gov/opioids/guideline-update/index.html CDC Drug Overdose Deaths Data (Including Prescription Opioids): https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm Initial Rx Opioid Duration compared to Probability of Continued Use: Shah A, et al. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017; 66: 265–269. Opioid and Benzo Combination tripling overdose death rate: Tae Woo Park, et al. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ 2015;350:h2698. 2016 CDC Chronic Pain Opioid Guideline: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
BREAKING NEWS: The 2022 CDC Opioid Guideline Update is published!!! Unless you'd like to read all 100 pages of the guideline publication on your own, you may want to start by listening to this episode at least once. Join the Mark “Pain Guy” Garofoli on the Pain Pod for a dynamic dissection of the 2022 CDC Opioid Guideline Update. Not a ton of actual updates compared to the 2016 guideline, but a half dozen that every clinician needs to be aware of, along with a handful a very specific reference checks leading to rather riveting conversations in the near future for you. “Pain Guy” will review all aspects of this incredibly important advancement in pain management so that you can correlate to your own patient care, educational efforts, or whatever setting you're in NOW. You may want to listen to this episode twice, and share it will everyone (seriously, all clinicians need to listen in, and patients in pain alike)!!! Come one, come all, to the Pain Pod!!! 2022 CDC Opioid Guideline Revision Resources 2022 CDC Opioid Guideline Update: CDC Chronic Pain Opioid Guidelines: MMWR March 2016. http://dx.doi.org/10.15585/mmwr.rr7103a1 CDC Opioid Guideline Update Timeline: https://www.cdc.gov/opioids/guideline-update/index.html CDC Drug Overdose Deaths Data (Including Prescription Opioids): https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm Initial Rx Opioid Duration compared to Probability of Continued Use: Shah A, et al. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017; 66: 265–269. Opioid and Benzo Combination tripling overdose death rate: Tae Woo Park, et al. Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study. BMJ 2015;350:h2698. 2016 CDC Chronic Pain Opioid Guideline: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
In episode 9 we discuss psilocybin for treating alcohol use disorder.Bogenschutz MP, Ross S, Bhatt S, et al. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(10):953–962. doi:10.1001/jamapsychiatry.2022.2096----------We talk about Wal-Mart and CVS not filling some telemedicine prescriptions. We also discuss gabapentin involvement in overdose deaths and the efficacy of gabapentin for neuropathic pain.Mattson CL, Chowdhury F, Gilson TP. Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:664–666Wiffen PJ, Derry S, Bell RF, Rice ASC, Tölle TR, Phillips T, Moore RA. Gabapentin for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD007938. DOI: 10.1002/14651858.CD007938.pub4. Accessed 21 October 2022----------This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. The best part of any journal club is the conversation, and we want to hear what you have to say. To have your opinions about the articles included in a future episode, send us your comments on Twitter or email, or join our Facebook group to continue the discussion.Email: addictionmedicinejournalclub@gmail.com Twitter: @AddictionMedJC Facebook: @AddictionMedJCCredits:Original theme music: composed and performed by Benjamin KennedyAudio production: Angela OhlfestAddiction Medicine Journal Club is intended for educational purposes only, and should not be considered medical advice. The views expressed here are our own, and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities.
SummaryWhat is your plan for medical care as you get older? Most people don't know. While 87% of people say they want to die at home, just under half of people do. In this episode we discuss goals of care, comfort care, palliative care, hospice, code status and more. Morbidity and MortalityMedical errors are the 3rd leading cause of death in the United States (sorry healthcare team…its true). As people get older, sicker, and frailer, their chances of being hurt by healthcare increase dramatically. At some point for everyone, the benefits of aggressive medical care are outweighed by the risks. StoryIn 1900 the average life expectancy in the United States was 47.3 years. By 2019, life expectancy had increased to 78.8 years. This was largely due to public health measures like clean water, lifesaving antibiotics, and vaccines. However, life expectancy is now trending down-ward. Key Points1. Comfort care is when the main goal of care is person's quality of life2. Palliative care is a medical discipline that helps people cope mentally, physically, and spiritually with severe illness. People on aggressive medical and comfort care can utilize palliative care.3. Code Status concerns a patient's wishes when they are dead. It has nothing to do with their medical care while alive.4. Hospice is a program centered around comfort care for those persons expected to live < 6 months. It is under-utilized and our current medical incentives push people away from it. References- Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar;33(3):238-46. - https://hospicefoundation.org/Hospice-Care/Hospice-Services- Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75. doi: 10.1146/annurev-publhealth-032013-182406. PMID: 24641562.- Gomes, B., Calanzani, N., Gysels, M. et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12, 7 (2013)- Adair T- Who dies where? Estimating the percentage of deaths that occur at home- BMJ Global Health 2021- QuickStats: Percentage of Deaths, by Place of Death — National Vital Statistics System, United States, 2000–2018. MMWR Morb Mortal Wkly Rep 2020- Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016- Google searches and numerous sites describing “comfort care”, “palliative care”, “End of life care”
"Pregnancy is no joke," Erin tells us in this body odyssey that's both deeply personal and all-too-common. Having been on bed rest with preeclampsia, Erin confides, “I wasn't good at being pregnant.” Weight gain and postpartum depression --a condition affecting 1 in 8 new moms-- made matters worse. But when a close friend and fellow high school teacher tells Erin that running might help her behavioral and physical challenges, she (begrudgingly) starts training for a marathon. “Each person needs a plan that is well suited for that personality and for their functioning level,” advises Dr. “Shosh” Bennett, a clinical psychologist who has personally struggled with postpartum. “The take-home message shouldn't be: I have to run a marathon in order to beat postpartum depression. It should be: Find something that's going to give them great satisfaction.” Does Mom-on-the-Run Erin find that satisfaction on a 26.2-mile run? Listen in to see how putting in extra miles helps her kids, her partner and herself. Original Music by Ryan Adair Rooney SHOW NOTES Expert: Dr. Shoshana Bennett, PhD Internationally recognized as the go-to expert on prenatal and postpartum depression and related mood and anxiety disorders, clinical psychologist Dr. Shoshana Bennett has inspired and transformed countless lives worldwide through her radio shows, books, lectures, interactive tele-classes, consultations, and videos. Books: Postpartum Depression For Dummies (2006) Beyond the Blues (2019) Links: Postpartum Action Institute Postpartum Support International Postpartum depression | Office on Women's Health Ko JY, Rockhill KM, Tong VT, Morrow B, Farr SL. Trends in Postpartum Depressive Symptoms: 27 States, 2004, 2008, and 2012. MMWR Morb Mortal Wkly Rep 2017; 66:153–158. Postpartum Depression: What You Need to Know (Mayo Clinic) More resources at www.mybodyodyssey.com Follow/Subscribe to the show so you don't miss an episode! And follow us on: Twitter: @mybodyodyssey Facebook: @mybodyodysseypod Instagram: @mybodyodysseypodcast
In the second episode of “No Shade, All Tea's” Season 2, host Dr. Nancy DiTunnariello talks with Kimberly Boley-Brown, BCBA, about her experience working with developmentally different individuals. Dr. D also shares an email (with permission from the writer) with Boley-Brown to gather feedback on how to help a mom in need. Show Info: Host: Dr. Nancy DiTunnariello, ditunnan@stjohns.edu Production: The Bolt Productions Intro/Outro Arrangement & Audio Editor: Courtney Lemkin Chief Audio Editor: Elizabeth Petrillo Chief Content Creator: Nicole Sutherland Show Linktree: https://linktr.ee/_NoShadeAllTea_ Photo Media: Cactus Girl Media Logo: Toni Sanchez Pop Art Guest Info: Name: Kimberly Boley-Brown Title: BCBA (Board Certified Behavior Analyst) Email: kimrboley@gmail.com Research Sources: Cicero, F. (2016). Promoting appropriate sexual behaviors for individuals on the autism spectrum: Effective curricula and teaching strategies. Retrieved July 7, 2022 from https://storage.outreach.psu.edu/autism/74-Presentation.pdf Okoro, C. A., Hollis, N. D., Cyrus, A.C., & Griffin-Blake, S. (2018). Prevalence of disabilities and health care Access by disability status and type among adults, MMWR Morb Mortal Wkly Rep., 67, 882–887. DOI: http://dx.doi.org/10.15585/mmwr.mm6732a3l Smeltzer, S., Mariani, B., & Meakin, C. (2017). “Communicating with people with disabilities.” Retreived on July 6, 2022, from: https://www.nln.org/education/teaching-resources/professional-development-programsteaching-resourcesace-all/ace-d/additional-resources/communicating-with-people-with-disabilities-e030c45c-7836-6c70-9642-ff00005f0421
Drs. Brian Werth (@bdubrx), Zack Nelson (@zacroBID) and Amy Brotherton (@AmyBrother10) join Dr. Jillian Hayes (@thejillianhayes) to discuss updates in the management of sexually transmitted infections. Listen in for guidance on how doses are selected, practical implementation of guideline changes, and how to discuss these changes with patients. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References St. Cyr S, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. doi: http://dx.doi.org/10.15585/mmwr.mm6950a6. STI treatment guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment-guidelines/default.htm. Published 2021. Accessed May 12, 2022. National overview – sexually transmitted Disease SURVEILLANCE, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/std/statistics/2019/overview.htm. Published April 13, 2021. Accessed May 12, 2022. Doan T, et al. N Engl J Med. 2020 Nov 12;383(20):1941-1950. doi: 10.1056/NEJMoa2002606. PMID: 33176084. Doan T, et al. N Engl J Med. 2019 Jun 6;380(23):2271-2273. doi: 10.1056/NEJMc1901535. PMID: 33167060. Kong FYS, et al. Clin Infect Dis. 2014 Jul 15;59(2):193-205. doi: 10.1093/cid/ciu220. PMID: 24729507. Dombrowski JC, et al. Clin Infect Dis. 2021 Sep 7;73(5):842-831. doi: 10.1093/cid/ciab153. PMID: 33606009. Connolly KL, et al. Antimicrob Agents Chemother. 2019 Feb 26;63(3):e01644-18. doi: 10.1128/AAC.01644-18. PMID: 30642924. Páez-Canro C, et al. Cochrane Database Syst Rev. 2019 Jan 25;1(1):CD010871. doi: 10.1002/14651858.CD010871.pub2. PMID: 30682211. Dukeres-Muijrers NHTM, et al. Sex Transm Infect. 2021 Mar;97(2):147-151. doi: 10.1136/sextrans-2020-054558. Epub 2020 Jul 31. PMID: 32737209. Manavi K, et al. Int J STD AIDS. 2016 Dec;27(14):1303-1308. doi: 10.1177/0956462415614723. Epub 2015 Oct 27. PMID: 26511655. Chisholm SA, et al. J Antimicrob Chemother. 2010 Oct;65(10):2141-8. doi: 10.1093/jac/dkq289. Epub 2010 Aug 6. PMID: 20693173. Kastner U, et al. Infection. 2001 Oct;29(5):251-6. doi: 10.1007/s15010-001-1072-3. PMID: 11688901. Dellamonica P. J Antimicrob Chemother. 2002 Oct;50(4):614-5. doi: 10.1093/jac/dkf166. PMID: 12356813. Davidson RJ. Infect Drug Resist. 2019 Mar 8;12:585-596. doi: 10.2147/IDR.S187226. PMID: 30881064. Burr LD, et al. Antimicrob Agents Chemother. 2022 Apr 19;66(4):e0224621. doi: 10.1128/aac.02246-21. PMID: 35293783. Hepatitis C State of Medicaid Access: https://stateofhepc.org Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.
Contributor: Jared Scott, MD Educational Pearls: About 50% of those infected with SARS-CoV-2 will shed the virus in their feces Wastewater surveillance can be used to track COVID burden, which may be easier than collating test data from multiple hospitals across a region Viral shedding begins 5-7 days prior to symptom onset, so wastewater data can be used to anticipate outbreaks and inform policy and public health initiatives Some existing limitations to wastewater surveillance include: Reporting by counties were water sources may be mixed Septic tanks and other closed water systems will not be counted Not all those infected will shed the virus References Weidhaas J, Aanderud ZT, Roper DK, et al. Correlation of SARS-CoV-2 RNA in wastewater with COVID-19 disease burden in sewersheds. Sci Total Environ. 2021;775:145790. doi:10.1016/j.scitotenv.2021.145790 Kirby AE, Walters MS, Jennings WC, et al. Using Wastewater Surveillance Data to Support the COVID-19 Response — United States, 2020–2021. MMWR Morb Mortal Wkly Rep 2021;70:1242–1244. DOI: http://dx.doi.org/10.15585/mmwr.mm7036a2 Covid-19 monitoring in wastewater. Colorado COVID-19 Updates. https://covid19.colorado.gov/covid-19-monitoring-in-wastewater. Accessed May 21, 2022. Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, MPH & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!
Did you know that there are an estimated 5 million human or animal bite wounds occur annually in the United States? Dog bite wounds are the most common, and infections rates can be as high as 50% for cat bite wounds. Today, pediatric resident, Dr. Jack Noel, joins pediatric emergency medicine physician, Dr. Jim Wilde, and pediatric emergency medicine fellow, Dr. Inna Kaminecki, to explore the common management strategies and potential pitfalls to avoid. Specifically, we will be covering the following: 1. Recognize common history and physical exam findings associated with animal and human bites. 2. Be able to recognize important pathogenic bacteria associated with animal and human bites. 3. Understand the initial diagnostic approach to animal and human bites. 4. Initiate appropriate prophylaxis in animal and human bites to prevent tetanus, rabies, and wound infection. 5. Initiate appropriate management of bite wounds. 6. Create an appropriate disposition for patient with bite wounds. FREE CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11167 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: 1. Bula-Rudas FJ, Olcott JL. Human and Animal Bites. Pediatr Rev. 2018 Oct;39(10):490-500. 2. Edens MA, Michel JA, Jones N. Mammalian Bites In The Emergency Department: Recommendations For Wound Closure, Antibiotics, And Postexposure Prophylaxis. Emerg Med Pract. 2016 Apr;18(4):1-20. 3. Centers for Disease Control and Prevention (CDC). Nonfatal dog bite-related injuries treated in hospital emergency departments-United States, 2001. MMWR Morb Mortal Wkly Rep. 2003 Jul 4;52(26):605-610. 4. Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, Clark TA. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2018 Apr 27;67(2):1-44. 5. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83. 6. American Academy of Pediatrics. Bite wounds. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:189–195. 7. American Academy of Pediatrics. Rabies. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:673-680. 8. American Academy of Pediatrics. Tetanus. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:793-798. 9. S. Ramgopal, M.L. Macy, US estimates for dog bite injuries presenting to emergency departments, Public Health, Volume 196, 2021,Pages 1-3, ISSN 0033-3506 https://doi.org/10.1016/j.puhe.2021.04.028.
Episode 90: Vaccines and Acne. Updates on pneumococcal and COVID-19 vaccines. Sarah explains the treatment of acne.New Pneumococcal Vaccine Recommendations. Written by Harkiran Bhattal, MS4, Ross University School of Medicine; Timiiye Yomi, MD; and Hector Arreaza, MD.During the recording, we used brand names because they are easier to use. We are not sponsored by the manufacturers of these vaccines. Terminology of pneumococcal vaccines: PCV13: Prevnar13®PPSV23: Pneumovax23®PCV15: Vaxneuvance® PCV20: Prevnar20®Tips about pneumococcal vaccines:-Prevnar13 is no longer used in adults. -Pneumovax23 is still being used in adults.-The two newer members of the pneumococcal vaccines are: Prevnar20® (PCV20) and Vaxneuvance® (PCV15). The following groups of patients are all adults 19-64 with underlying conditions OR >65 years old. Group A: Unknown or no prior doses of Prevnar13 or Pneumovax 23Option 1: Prevnar20 given as a single doseOption 2: Vaxneuvance followed by a dose of Pneumovax23 at least a year later (Consider >8 weeks in patients >19 at the highest risk)Group B: Previously received Pneumovax 23Give Prevnar20 or Vaxneuvance (at least 1 year since the last Pneumovax 23)Group C: Previously Received Prevnar13Give Pneumovax23 or Prevnar20 (if Pneumovax 23 is not available) >1 year since last dose of Prevnar13Group D: Previously completed series of Prevnar13 and Pneumovax23 in any orderNo additional doses are needed. Scenario 1: 68 yo M who has not previously received PCV or whose previous vaccination history is unknown (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed by a dose of Pneumovax23. Scenario 2: 25 yo F with HIV not previously received PCV or whose vaccination history is unknown (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed bya dose of Pneumovax 23 given 8 weeks later. This patient is in the highest risk group. Scenario 3: 50 yo M with chronic alcoholism who has not received any vaccine or unknown status (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed by Pneumovax 23 one year later. Scenario 4: 43 yo M with previous Pneumovax 23 only (Group B). This patient should receive either: a single dose of Prevnar20 or Vaxneuvance and be done with either vaccine. Give either vaccine at least 1 year after Pneumovax 23. Scenario 5: 25 yo F with CSF leak and previously received Prevnar13 (Group C). This patient should receive Pneumovax23 or Prevnar 20 (if Pneumovax 23 is unavailable) at least one year after her las Pneumovax dose. Scenario 6: 35 yo M who previously completed Prevnar13 and Pneumovax in any order because he has a cochlear implant (Group D). This patient should NOT receive any additional dose. Research and MonitoringCDC and ACIP will continue to assess the safety of Vaxneuvance and Prevnar20 vaccines (the new kids on the block), monitor the impact of the implementation of new recommendations, and assess post-implementation effectiveness and recommendations as appropriate. Examples of risk factors to consider administration of pneumococcal vaccines: Chronic renal failure, HIV infection, alcoholism, cigarette smoking, chronic heart, liver, and lung disease. For a complete list of conditions, visit CDC.gov.___________________ A second booster shot of COVID-19 vaccines. By Hector Arreaza, MD.On March 29 and 30, 2022, CDC announced that a second booster dose of any mRNA COVID-19 vaccine may be given to certain individuals who are at risk of severe outcomes from COVID-19(1). Individuals who may choose to receive a second booster are: 1. People older than 12 years of age who have a moderate to severe immunocompromising condition. Remember, use Pfizer for older than 12 yo, and Moderna for older than 18 yo.2. People older than 50 years of age who are NOT moderately or severely immunocompromised.3. People 18-49 years of age who are NOT immunocompromised but received the J&J COVID-19 vaccine as both the primary and booster dose. When can you receive the second booster shot? At least 4 months after the first booster dose.Who is considered up to date? A person is considered up to date when he/she has received all recommended doses in their primary vaccine series, and a booster dose when eligible. A second booster dose is not required to be considered up to date at this time.Underlying medical conditions associated with higher risk for severe COVID-19 include: Cancer, obesity, cerebrovascular disease, diabetes mellitus, HIV, obesity, COPD, smokers, and chronic liver disease.Comment: Remember to give the second booster to your patients. ____________________Acne Treatment. By Sarah Park, MS3, University of California Los Angeles. Discussed with Hector Arreaza, MD. Definition: Acne vulgaris is a common inflammatory disorder of the pilosebaceous unit, which includes the hair follicle and sebaceous gland. It is characterized by chronic or recurrent development of papules, pustules, or nodules commonly on the face, chest, or upper back.(1,2) Acne affects nearly 50 million people in the U.S. per year and can cause significant psychological distress in those who are affected. It primarily begins at puberty when the production of androgens and/or sensitivity of androgen receptors increase, thereby commonly affecting adolescents and young adults.(2) Pathophysiology: The pathophysiology of acne involves four main processes: 1) sebum overproduction, 2) hyperkeratinization of the follicle, 3) bacterial colonization by Cutibacterium acnes, and 4) inflammation.(2,3) It can be classified as mild, moderate, or severe based on the extent and types of lesions.3Treatment: Treatment is selected based on the severity of the condition, patient preference, and tolerability. Acne treatment often requires long-term, consistent use of one or more medications.(3) The main objective of treatment is to decrease sebum production, get rid of extra keratin, treat infection and decrease inflammation. You can warn your patients that their skin may feel dryer and more scaly than usual, but that's part of the treatment. For mild and exclusively comedonal acne, topical retinoids like tretinoin are the treatment of choice(4), but topical retinoids can be used in any level of severity for maintenance. Examples: Adapelene, tazarotene, and tretinoin, For mild inflammatory papulopustular acne or mild mixed comedonal and papulopustular acne, topical retinoids may be used in combination with antimicrobial therapy (either combined with benzoyl peroxide or combined with benzoyl peroxide plus clindamycin or erythromycin). If patients cannot tolerate a topical retinoid, alternatives include salicylic acid and azelaic acid. Of note, oral or topical antibiotics should only be used in combination with benzoyl peroxide and retinoids for a maximum of 12 weeks. If unresponsive to these topical therapies, namely retinoids, benzoyl peroxide, and/or clindamycin, alternative therapies may be initiated. These include topical dapsone, minocycline, and clascosterone.Topical dapsone is an effective treatment for both inflammatory papulopustular and comedonal acne lesions. Topical minocycline is an alternative topical antibiotic used for specifically moderate to severe acne. And last but not least is topical clascosterone, a relatively new topical (specifically an androgen receptor inhibitor) approved by the FDA in 2020.(4)Treatment for moderate to severe acne: For moderate to severe acne vulgaris, management is systemic therapy. This includes oral antibiotics or hormonal therapies, often used in conjunction with topical therapy, or monotherapy with oral isotretinoin. 1. Oral antibiotics for acne vulgaris include doxycycline, minocycline, and sarecycline. Treatment should be limited to three to four months.(5)2. For female patients, hormonal therapy with oral contraceptives and/or spironolactone is also an option. A meta-analysis comparing oral contraceptive therapy and oral antibiotic therapy suggests similar efficacy for the treatment of acne. OCP treatment is often the first-line choice for hormonal therapy, especially for patients who desire the added benefit of contraception. Spironolactone is often used for patients who have contraindications to OCP therapy or prefer to avoid OCPs. Both methods work to inhibit acne by reducing the effects of androgen on the pilosebaceous unit.53. For severe, extensive, nodular acne vulgaris, oral isotretinoin is the drug of choice. It is given as a monotherapy and is often used when all other treatment modalities fail. Oral isotretinoin is the only medication that can permanently affect the natural course of acne by affecting all four factors in acne pathogenesis. Isotretinoin is most notably known for its teratogenic adverse effects and so is contraindicated in pregnant women and pregnancy must be avoided during therapy by using two forms of birth control.(5)Comment about isotretinoin use: Although prescribing isotretinoin (brand name Accutane®) is within the scope of family medicine, many providers choose not to prescribe it because of lack of training, monitoring hassles, fear of side effects, especially due to concerns with teratogenicity. Isotretinoin is an effective treatment for a condition that can not only disfigure and scar the face but can also cause significant psychosocial dysfunction. Dr. Van Durme recommended when you prescribe isotretinoin, you should have a regular schedule of monthly laboratory tests (including pregnancy test), then office visit, and then prescription, in that order. This schedule will improve the likelihood that side effects are managed promptly and medication is taken appropriately(7). If you would like more information about prescribing isotretinoin, visit https://ipledgeprogram.com.Conclusion: Use topical retinoids alone for mild cases of acne; topical retinoids combined with benzoyl peroxide or topical clindamycin or erythromycin for moderate cases; and topical retinoids combined with benzoyl peroxide and oral antibiotics in severe cases. Remember that isotretinoin is an oral treatment reserved for severe inflammatory papules and pustules with nodules. Treating acne effectively can certainly improve the quality of life of your patients. Now we conclude Episode 90 “Vaccines and Acne”. We gave you an update on pneumococcal and COVID-19 vaccines. Prevnar 20 seems to be the new star in the show. PCV15 is also useful but it needs to be followed by a shot of Pneumovax 23. Regarding COVID-19 vaccines, a second shot may be given to patients older than 12 who are immunocompromised or patients older than 50 who are NOT immunocompromised. Then we finished with a discussion about acne and we learned that topical is usually enough for mild cases, but oral therapy may be needed in moderate to severe cases of acne. Even without trying, every night you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek. Send us your feedback by email to RioBravoqWeek@clinicasierravista.org, or in our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Timiiye Yomi, Amardeep Chetha and Sarah Park. Audio edition: Suraj Amrutia. See you next week! References:Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109–117. DOI: http://dx.doi.org/10.15585/mmwr.mm7104a1 2. Pneumococcal Vaccination Timing for Adults, CDC. https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf, accessed on March 30, 2022. Interim Clinical Considerations for Use of COVID-19 Vaccines, Centers for Disease Control and Prevention, CDC.gov, https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-booster, accessed April 5, 2022. Thiboutot, Diane, MD; and Andrea L Zaenglein, MD. Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-acne-vulgaris Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021 Oct 11;10:2021-8-6. doi: 10.7573/dic.2021-8-6. PMID: 34691199; PMCID: PMC8510514. Oge' LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. Am Fam Physician. 2019 Oct 15;100(8):475-484. PMID: 31613567. Graber, Emmy, MD, MBA. Acne vulgaris: Overview of management, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/acne-vulgaris-overview-of-management Harris C. Clascoterone (Winlevi) for the Treatment of Acne. Am Fam Physician. 2021 Jul 1;104(1):93-94. PMID: 34264597. Acne vulgaris: Management of moderate to severe acne, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/acne-vulgaris-management-of-moderate-to-severe-acne Van Durme DJ. Family physicians and accutane. Am Fam Physician. 2000 Oct 15;62(8):1772, 1774, 1777. PMID: 11057835. https://www.aafp.org/afp/2000/1015/p1772.html
Description: A year ago, we published an episode looking at diabetes management in the context of ongoing restrictions in many parts of the world. Since then, a wealth of clinical data has continued to be published on the bidirectional relationship between diabetes and Covid-19, so today we're taking a closer look at these data. We're joined by Professor Partha Kar, National Specialty Advisor, Diabetes for NHS England, to discuss what the data mean for clinical practice. 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 https://diabetes.knowledgeintopractice.com, where you can find all past episodes of the podcast as well as other free CME resources. References: Kamrath C, et al. Incidence of Type 1 Diabetes in Children and Adolescents During the COVID-19 Pandemic in Germany: Results From the DPV Registry. Diabetes Care. 2022 Jan 17:dc210969. Gottesman BL, et al. Incidence of New-Onset Type 1 Diabetes Among US Children During the COVID-19 Global Pandemic. JAMA Pediatr. 2022 Apr 1;176(4):414-415. McGlacken-Byrne SM, et al. The SARS-CoV-2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi-centre study of the first COVID-19 wave. Diabet Med. Sep 2021;38(9):e14640. Barrett CE, et al. Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-259 Overview: Per CDC data, approximately 2.5 million Americans present each year to emergency departments with head injuries, and 15% of all high school students report experiencing at least one concussion. Current guidelines recommend physical and cognitive rest for 24-48 hours post-concussion with minimal guidance on screen time parameters. Recent evidence is emerging that supports avoidance of screen time and encouragement of aerobic activity as strategies to shorten and lessen post-concussion symptoms. Join us as we discuss 2 recent studies regarding screen-time and aerobic exercise that add critical information to best practice for reducing post-concussion symptoms. Episode resource links: John J Leddy, Christina L Master, Rebekah Mannix, Douglas J Wiebe, Matthew F Grady, William P Meehan, Eileen P Storey, Brian T Vernau, Naomi J Brown, Danielle Hunt, Fairuz Mohammed, Andrea Mallon, Kate Rownd, Kristy B Arbogast, Adam Cunningham, Mohammad N Haider, Andrew R Mayer, Barry S Willer. Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial. The Lancet Child & Adolescent Health, 2021; DOI: 10.1016/S2352-4642(21)00267-4 Macnow T, Curran T, Tolliday C, et al. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. Published online September 07, 2021. doi:10.1001/jamapediatrics.2021.2782 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2783638#graphical-abstract-tab DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self-reported concussions from playing a sport or being physically active among high school students—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(24):682-685. doi:10.15585/mmwr.mm6724a3 University at Buffalo. (2021, September 30). Aerobic exercise after a sport-related concussion speeds recovery in adolescent athletes, study suggests: Daily aerobic exercise significantly reduced the risk of prolonged recovery. ScienceDaily. Retrieved October 2, 2021 from www.sciencedaily.com/releases/2021/09/210930213654.htm McCrory P ,Meeuwisse W,Dvorak J,etal. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017- 097699 Centers for Disease Control and Prevention. Recovery from concussion. Centers for Disease Control and Prevention; 2019. Accessed October 12, 2020. https://www.cdc.gov/headsup/basics/ concussion_recovery.html. Guest: Guest Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-259 Overview: Per CDC data, approximately 2.5 million Americans present each year to emergency departments with head injuries, and 15% of all high school students report experiencing at least one concussion. Current guidelines recommend physical and cognitive rest for 24-48 hours post-concussion with minimal guidance on screen time parameters. Recent evidence is emerging that supports avoidance of screen time and encouragement of aerobic activity as strategies to shorten and lessen post-concussion symptoms. Join us as we discuss 2 recent studies regarding screen-time and aerobic exercise that add critical information to best practice for reducing post-concussion symptoms. Episode resource links: John J Leddy, Christina L Master, Rebekah Mannix, Douglas J Wiebe, Matthew F Grady, William P Meehan, Eileen P Storey, Brian T Vernau, Naomi J Brown, Danielle Hunt, Fairuz Mohammed, Andrea Mallon, Kate Rownd, Kristy B Arbogast, Adam Cunningham, Mohammad N Haider, Andrew R Mayer, Barry S Willer. Early targeted heart rate aerobic exercise versus placebo stretching for sport-related concussion in adolescents: a randomised controlled trial. The Lancet Child & Adolescent Health, 2021; DOI: 10.1016/S2352-4642(21)00267-4 Macnow T, Curran T, Tolliday C, et al. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. Published online September 07, 2021. doi:10.1001/jamapediatrics.2021.2782 https://jamanetwork.com/journals/jamapediatrics/article-abstract/2783638#graphical-abstract-tab DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self-reported concussions from playing a sport or being physically active among high school students—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(24):682-685. doi:10.15585/mmwr.mm6724a3 University at Buffalo. (2021, September 30). Aerobic exercise after a sport-related concussion speeds recovery in adolescent athletes, study suggests: Daily aerobic exercise significantly reduced the risk of prolonged recovery. ScienceDaily. Retrieved October 2, 2021 from www.sciencedaily.com/releases/2021/09/210930213654.htm McCrory P ,Meeuwisse W,Dvorak J,etal. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017- 097699 Centers for Disease Control and Prevention. Recovery from concussion. Centers for Disease Control and Prevention; 2019. Accessed October 12, 2020. https://www.cdc.gov/headsup/basics/ concussion_recovery.html. Guest: Susan Feeney, DNP, FNP-BC, NP-C Music Credit: Richard Onorato
This week we will hear Ashley Hall's story -- told by her Mother Lucia, and her sister Jessa. Please note, due to the public nature of this story, real names will be used for this episode. *Content warning: This episode contains descriptions of psychological and physical violence, and murder. **Resources: The Domestic Violence Hotline offers free and confidential support, 24/7 at 1.800.799.SAFE (7233), text "START" to 88788 or chat with someone confidentially at https://www.thehotline.orgThe National Coalition Against Domestic Violence (NCADV)'s mission is to lead, mobilize and raise our voices to support efforts that demand a change of conditions that lead to domestic violence such as patriarchy, privilege, racism, sexism, and classism. We are dedicated to supporting survivors and holding offenders accountable and supporting advocates. https://ncadv.org/contact-usFor more free mental health resources, please visit SomethingWasWrong.com/Resources Sources: Emma E. Fridel and James Alan Fox: Gender Differences in Patterns and Trends in U.S. Homicide, 1976–2017 http://doi.org/10.1089/vio.2019.0005Violence and Gender: Published in Volume: 6 Issue 1: March 11, 2019Petrosky E, Blair JM, Betz CJ, Fowler KA, Jack SP, Lyons BH: Racial and Ethnic Differences in Homicides of Adult Women and the Role of Intimate Partner Violence: United States, 2003–2014. MMWR Morb Mortal Wkly Rep 2017; 66:741–746. Jul 21;66(28):741-746. doi: 10.15585/mmwr.mm6628a1. PMID: 28727682; PMCID: PMC5657947.Government of Western Australia Department of Communities Child Protection and Family Support: Fact Sheet 3: Perpetrator Characteristics Adapted from: Perpetrator accountability in Child Protection Practice – A resource for child protection workers about engaging and responding to men who perpetrate family and domestic violence, Department for Child Protection, Government of Western Australia, 2013.The Press-Enterprise: CRIME BLOTTER: San Bernardino woman brutally stabbed; husband sought: Youtube: https://www.youtube.com/watch?v=VOOL-eQkubQ December 3rd 2013**Something Was Wrong's theme song was originally composed by Glad Rags and is covered this season by Kenna and the Kings. Support and listen to Kenna and the Kings on Spotify, YouTube , and check out their albums!
Educational Pearls: Recent updates to treatment guidelines increased the 250 mg ceftriaxone IM dose to 500 mg ceftriaxone IM IM dosing can be very painful, so other methods of administration can help decrease pain for patients Using IV ceftriaxone instead of IM has no significant difference in pharmacokinetics or bioavailability, so it can be considered in patients with an IV already placed References St Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(50):1911-1916. Published 2020 Dec 18. doi:10.15585/mmwr.mm6950a6 Product Information: ROCEPHIN(R) IV, IM injection, ceftriaxone sodium IV, IM injection. Genentech USA, Inc. (per Manufacturer), South San Francisco, CA, 2010. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today! Diversity and Inclusion Award
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus). PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatomal distribution. Pain from PHN is typically sustained for at least 90 days after the rash. PHN is caused by nerve injury due to the inflammatory response induced by viral replication within the nerve. Epidemiologic studies have found that PHN occurs in about 20% of patients who have Herpes Zoster. With the relatively recent development of the preventative vaccine Shingrix (which has been found to be 97% effective in preventing Herpes Zoster) it is anticipated that the total prevalence of Herpes Zoster and PHN will decrease. However, research has repeatedly demonstrated that immunocompromised patients are at a significantly increased risk for Herpes Zoster and PHN (20-100 times increased risk of development of PHN). As of today, the Advisory Committee on Immunization Practices has not cleared immunocompromised patients to receive the Shingrex (or Zostavax) vaccine; therefore for multiple reasons PHN will most likely continue to be a prevalent diagnosis. Treatment options for PHN include physical modalities (TENS, desensitization), topical medications (including Lidocaine 5% patch, and Capsaicin), oral medications (including Gabapentin, Pregabalin, Tricyclic Antidepressants), and procedures. Listen as the doctors review Herpes Zoster, PHN, and a recent research article evaluating the effect of the Erector Spinae Plane Block in regards to prevention of PHN once Herpes Zoster has already developed. 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 counsel 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. Zeng-Mao Lin, MD, Hai-Feng Wang, MD, Feng Zhang, MD, Jia-Hui Ma, MD, PhD, Ni Yan, RN, and Xiu-Fen Liu, MD. The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial. 2021;24;E1109-E1118. 2. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108.
Jacinda Abdul-Mutakabbir (@jayCdoesID) and Jeannette Bouchard (@jlbouchard001) join Erin McCreary (@ErinMcCreary) to discuss COVID vaccines, including access to, confidence in, and hesitancy around them. This episode was sponsored by an unrestricted educational grant from Janssen Therapeutics, Division of Janssen Products, LP References: Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020;383:2603-2615. Baden LR, El Sahly HM, Essink B, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med 2021;384:403-416. Sadoff J, Gray G, Vandebosch A, et al. Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. N Engl J Med 2021 Rosenblum HG, Hadler SC, Moulia D, et al. Use of COVID-19 Vaccines After Reports of Adverse Events Among Adult Recipients of Janssen (Johnson & Johnson) and mRNA COVID-19 Vaccines (Pfizer-BioNTech and Moderna): Update from the Advisory Committee on Immunization Practices — United States, July 2021. MMWR Morb Mortal Wkly Rep 2021;70:1094-1099. DOI: http://dx.doi.org/10.15585/mmwr.mm7032e4external icon. Rapaka RR, Hammershaimb EA, Neuzil KM. Are some COVID vaccines better than others? Interpreting and comparing estimates of efficacy in trials of COVID-19 vaccines [published online ahead of print, 2021 Mar 6]. Clin Infect Dis. 2021;ciab213. doi:10.1093/cid/ciab213 ACIP Website: https://www.cdc.gov/vaccines/acip/index.html Marcelin JR, Swartz TH, Bernice F, et al. Addressing and Inspiring Vaccine Confidence in Black, Indigenous, and People of Color (BIPOC) during the COVID-19 Pandemic. [published online ahead of print, 2021 Aug 9]. Open Forum Infect Dis. 2021. Doi: 10.1093/ofid/ofab417 Abdul-Mutakabbir JC, Casey S, Jews V, et al. A three-tiered approach to address barriers to COVID-19 vaccine delivery in the Black community. Lancet Glob Health. 2021 Jun;9(6):e749-e750. doi: 10.1016/S2214-109X(21)00099-1. Epub 2021 Mar 10. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-239 Overview: Join us to discuss the CDC's new guidelines for the management of sexually transmitted infections due to Neisseria gonorrhoeae. You'll walk away with recommendations for how to address urogenital, rectal, and pharyngeal infections. You'll also discover alternative regimens for patients allergic to first-line therapy and understand how to manage coinfection with chlamydia. Episode resource links: St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–191 Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato
Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-239 Overview: Join us to discuss the CDC's new guidelines for the management of sexually transmitted infections due to Neisseria gonorrhoeae. You'll walk away with recommendations for how to address urogenital, rectal, and pharyngeal infections. You'll also discover alternative regimens for patients allergic to first-line therapy and understand how to manage coinfection with chlamydia. Episode resource links: St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–191 Guest: Alan Ehrlich MD, FAAFP Music Credit: Richard Onorato
This week, low-dose azithromycin did not improve cough in patients with IPF; tele-pulmonary rehab may lower barriers to care; the J&J vaccine provides 8-month protection from the delta variant; a daily ECMO liberation protocol was found to be safe and feasible; and portable air cleaners could reduce exposure to SARS-CoV-2 aerosols. Read the full coverage here: Study does not support low-dose azithromycin to treat chronic cough in IPF Telehealth pulmonary rehabilitation program for COPD accessible, feasible, safe J&J vaccine protects against delta variant for at least 8 months, studies find ECMO-free protocol feasible, may aid earlier identification of patients for decannulation Portable air cleaners could reduce exposure to SARS-CoV-2 aerosols, study finds References: Alwakeel AJ, et al. Ann Am Thorac Soc. 2021;doi:10.1513/AnnalsATS.202006-638OC. Gannon WD, et al. Chest. 2021;doi:10.1016/j.chest.2021.05.066. Guler SA, et al. Ann Am Thorac Soc. 2021;doi:10.1513/AnnalsATS.202103-266OC. Lindsley WG, et al. MMWR Morb Mortal Wkly Rep. 2021;doi:10.15585/mmwr.mm7027e1.
At least 3.4+ Million Live with Epilepsy in the U.S.2National Neurology Expert Offers Immediate Steps to Mitigate Deadly Risks, ReduceRelated Healthcare Costs and BurdenGUEST: Dr. James Wheless, Professor and Chief of Pediatric Neurology, Le Bonheur Chair in Pediatric Neurology, University of Tennessee Health Science CenterBackground:Epilepsy is a disorder of the brain that is characterized by seizures.3 Seizures can be debilitating and even life threatening.4 Just one convulsive seizure is a potentially shattering event that increases the risk of significant health consequences, including physical injury and cognitive decline.5,6,7 Although epilepsy is widely recognized, few understand it – even those who know someone with the disorder.1 And this misunderstanding causes a stigma that makes it harder to treat,1 while the number of adults and children challenged by epilepsy in the U.S. is increasing.2Freedom from seizures is the ultimate goal in epilepsy treatment.8 Yet missed doses are a common occurrence that can get in the way of achieving it. For most people with this condition, it's a question of when, not if they will miss a dose of their medication. In fact, 71% of epilepsy patients surveyed have missed at least 1 dose.9 And, almost 50% report that a missed dose of medication was followed by a subsequent seizure.9 Poor seizure control means a higher likelihood of emergency room visits and greater healthcare costs.10 Yet many with epilepsy may be reluctant to discuss their struggles even with their doctor.11Dr. James Wheless, Professor and Chief of Pediatric Neurology, Le Bonheur Chair in Pediatric Neurology, University of Tennessee Health Science Center will help educate your viewers about epilepsy, including the crucial role of individual lifestyle in treatment, and advances in epilepsy management that will help people living with epilepsy achieve seizure freedom.More information can be found at www.epilapsey.comMore About Dr. James WhelessDr. Wheless is Professor and Chief of Pediatric Neurology and the Le Bonheur Chair in Pediatric Neurology at the University of Tennessee Health Science Center in Memphis. He also serves as Director of the Neuroscience Institute and the Le Bonheur Comprehensive Epilepsy Program for the Le Bonheur Children's Hospital.Dr. Wheless is a paid consultant on behalf of Eisai Inc.REFERENCEHerrmann LK, et al. Epilepsy misconceptions and stigma reduction: Current status in Western Countries. Epilepsy Behav. 2016;60:165-173.Zack MM, Kobau R. National and State Estimates of the Numbers of Adults and Children with Active Epilepsy — the United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66:821–825.Institute of Medicine Committee on the Public Health Dimensions of the Epilepsies. Summary. Epilepsy Across the Spectrum: Promoting Health and Understanding. England MJ, Liverman CT, Schultz AM, Strawbridge LM, editors. Washington, DC: National Academies Press; 2012.Harden C, et al. Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsy Currents. 2015;17(3):180-187.Friedman DE, et al. Recurrent seizure-related injuries in people with epilepsy at a tertiary epilepsy center: A 2-year longitudinal study. Epilepsy Behav. 2010;19(3):400-404.Thompson PJ, Duncan JS. Cognitive decline in severe epilepsy. Epilepsia. 2005;45(11):1780-1787.Berg AT, et al. Mortality risks in new-onset childhood epilepsy. Pediatrics. 2013;132(1):124-131St. Louis, EK. Minimizing AED Adverse Effects: Improving Quality of Life in the Interictal State in Epilepsy Care. Current Neuropharmacol. 2009;7:106-114.Cramer JA, Glassman M, Rienzi V. The relationship between poor medication compliance and seizures. Epilepsy Behav. 2002;3:338-342.Divino V, Petrilla AA, Bollu V, et al. Clinical and economic burden of breakthrough seizures. Epilepsy Behav. 2015;51:40-47.Buelow J, Miller W, Fishman J. Development of an Epilepsy Nursing Communication Tool: Improving the Quality of Interactions Between Nurses and Patients with Seizures. Jour of Neurosci Nurs. 2018;50(2):74-80.
At least 3.4+ Million Live with Epilepsy in the U.S.2National Neurology Expert Offers Immediate Steps to Mitigate Deadly Risks, ReduceRelated Healthcare Costs and BurdenGUEST: Dr. James Wheless, Professor and Chief of Pediatric Neurology, Le Bonheur Chair in Pediatric Neurology, University of Tennessee Health Science CenterBackground:Epilepsy is a disorder of the brain that is characterized by seizures.3 Seizures can be debilitating and even life threatening.4 Just one convulsive seizure is a potentially shattering event that increases the risk of significant health consequences, including physical injury and cognitive decline.5,6,7 Although epilepsy is widely recognized, few understand it – even those who know someone with the disorder.1 And this misunderstanding causes a stigma that makes it harder to treat,1 while the number of adults and children challenged by epilepsy in the U.S. is increasing.2Freedom from seizures is the ultimate goal in epilepsy treatment.8 Yet missed doses are a common occurrence that can get in the way of achieving it. For most people with this condition, it's a question of when, not if they will miss a dose of their medication. In fact, 71% of epilepsy patients surveyed have missed at least 1 dose.9 And, almost 50% report that a missed dose of medication was followed by a subsequent seizure.9 Poor seizure control means a higher likelihood of emergency room visits and greater healthcare costs.10 Yet many with epilepsy may be reluctant to discuss their struggles even with their doctor.11Dr. James Wheless, Professor and Chief of Pediatric Neurology, Le Bonheur Chair in Pediatric Neurology, University of Tennessee Health Science Center will help educate your viewers about epilepsy, including the crucial role of individual lifestyle in treatment, and advances in epilepsy management that will help people living with epilepsy achieve seizure freedom.More information can be found at www.epilapsey.comMore About Dr. James WhelessDr. Wheless is Professor and Chief of Pediatric Neurology and the Le Bonheur Chair in Pediatric Neurology at the University of Tennessee Health Science Center in Memphis. He also serves as Director of the Neuroscience Institute and the Le Bonheur Comprehensive Epilepsy Program for the Le Bonheur Children's Hospital.Dr. Wheless is a paid consultant on behalf of Eisai Inc.REFERENCEHerrmann LK, et al. Epilepsy misconceptions and stigma reduction: Current status in Western Countries. Epilepsy Behav. 2016;60:165-173.Zack MM, Kobau R. National and State Estimates of the Numbers of Adults and Children with Active Epilepsy — the United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66:821–825.Institute of Medicine Committee on the Public Health Dimensions of the Epilepsies. Summary. Epilepsy Across the Spectrum: Promoting Health and Understanding. England MJ, Liverman CT, Schultz AM, Strawbridge LM, editors. Washington, DC: National Academies Press; 2012.Harden C, et al. Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsy Currents. 2015;17(3):180-187.Friedman DE, et al. Recurrent seizure-related injuries in people with epilepsy at a tertiary epilepsy center: A 2-year longitudinal study. Epilepsy Behav. 2010;19(3):400-404.Thompson PJ, Duncan JS. Cognitive decline in severe epilepsy. Epilepsia. 2005;45(11):1780-1787.Berg AT, et al. Mortality risks in new-onset childhood epilepsy. Pediatrics. 2013;132(1):124-131St. Louis, EK. Minimizing AED Adverse Effects: Improving Quality of Life in the Interictal State in Epilepsy Care. Current Neuropharmacol. 2009;7:106-114.Cramer JA, Glassman M, Rienzi V. The relationship between poor medication compliance and seizures. Epilepsy Behav. 2002;3:338-342.Divino V, Petrilla AA, Bollu V, et al. Clinical and economic burden of breakthrough seizures. Epilepsy Behav. 2015;51:40-47.Buelow J, Miller W, Fishman J. Development of an Epilepsy Nursing Communication Tool: Improving the Quality of Interactions Between Nurses and Patients with Seizures. Jour of Neurosci Nurs. 2018;50(2):74-80.
TITLE: Multisystem Inflammatory Disease in Children (MIS-C) Last Updated: January 22, 2021 PARTICIPANTS: Hosts: Sonal Dugar, Zachary Hodges, Pushpa Shivaram, Julisa Patel Peer Reviewer #1: Smitha Mathew Peer Reviewer #2: Reda Bassali By the end of listening to this podcast, learners should be able to: Recognize the general clinical presentation of MIS-C. Create a differential diagnosis for children presenting with a non-specific hyperinflammatory syndrome. Recall the CDC case definition of MIS-C. Recall the general approach to the initial evaluation of a patient with possible MIS-C. Compare and contrast the general presentation of MIS-C and Kawasaki disease. Recall the initial treatment of MIS-C including supportive care, IVIG and corticosteroids. Recall that anakinra and other immunomodulating drugs may be indicated for refractory MIS-C. Recognize that aspirin and anticoagulation may be indicated in severe cases of MIS-C. Recall the follow-up required for children with moderate to severe COVID-19 and MIS-C prior to return to normal activities. Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Visit our website at https://www.augusta.edu/mcg/pediatrics/residency/podcast.php for more information and show-notes. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast. References: Godfred-Cato S, Bryant B, Leung J, et al. COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1074–1080. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e2external icon Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607–8. Dufort EM, Koumans EH, Chow EJ, et al.; New York State and CDC Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020;383:347–58. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334-346. doi:10.1056/NEJMoa2021680 Whittaker E, Bamford A, Kenny J, et al.; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020;324:259–69. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS‐C) Associated with SARS‐CoV‐2 and Hyperinflammation in COVID‐19. Version 1. Arthritis Rheumatol doi: https://onlinelibrary.wiley.com/doi/10.1002/art.41454. Abrams JY, Godfred-Cato SE, Oster ME, Chow EJ, Koumans EH, Bryant B, Leung JW, Belay ED, Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2: A Systematic Review, The Journal of Pediatrics (2020), doi: https://doi.org/10.1016/jpeds.2020.08.003. 1161.CIRCULATIONAHA.120.049836. Review of Cardiac Involvement in MISC. Circulation Kaushik, Ashlesha MD*; Gupta, Sandeep MD†; Sood, Mangla MD‡; Sharma, Seema MD§; Verma, Shikha MD§ A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection, The Pediatric Infectious Disease Journal: November 2020 - Volume 39 - Issue 11 - p e340-e346 doi: 10.1097/INF.0000000000002888 CDC MIS-C Information Webpage. https://www.cdc.gov/mis-c/cases/index.html
In Episode 6 Jeff and Yolanda discuss the inauguration and race in America from their unique perspectives. What does it mean to be Black? They also discuss the troubling statistics in education, healthcare, and economics. Jeff provides his thoughts on when we will know the pandemic is over. We greatly appreciate all the support we have received. Please follow us on Instagram @thesoulpourpodcast and on Facebook facebook.com/thesoulpourpodcast. Please rate and subscribe! Contact us at thesoulpourpodcast@gmail.com Sources: https://www.census.gov/newsroom/press-releases/2020/educational-attainment.html https://www.statista.com/statistics/233324/median-household-income-in-the-united-states-by-race-or-ethnic-group/ https://www.marketwatch.com/story/college-graduation-rates-for-african-americans-are-at-an-all-time-high-so-why-arent-their-finances-2018-03-01 Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;68:423–429. DOI: http://dx.doi.org/10.15585/mmwr.mm6818e1external icon. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
In Episode 6 Jeff and Yolanda discuss the inauguration and race in America from their unique perspectives. What does it mean to be Black? They also discuss the troubling statistics that Blacks lag in education, healthcare, and economics. Jeff provides his thoughts on when we will know the pandemic is over. We greatly appreciate all the support we have received. Please follow us on Instagram @thesoulpourpodcast and on Facebook facebook.com/thesoulpourpodcast. Contact us at thesoulpourpodcast@gmail.com Sources: https://www.census.gov/newsroom/press-releases/2020/educational-attainment.html https://www.statista.com/statistics/233324/median-household-income-in-the-united-states-by-race-or-ethnic-group/ https://www.marketwatch.com/story/college-graduation-rates-for-african-americans-are-at-an-all-time-high-so-why-arent-their-finances-2018-03-01 Suggested citation for this article: Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;68:423–429. DOI: http://dx.doi.org/10.15585/mmwr.mm6818e1external icon. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
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