Podcasts about pmid

Listener discretion is advised. References: Christine Witten. Airway Jedi Blog. Available: https://airwayjedi.com/2019/01/24/etco2-valuable-vital-sign-perfusion/ Dubin A, Murias G, Estenssoro E, Canales H, Sottile P, Badie J, Barán M, Rossi S, Laporte M, Pálizas F, Giampieri J, Mediavilla D, Vacca E, Botta D. End-tidal CO2 pressure determinants during hemorrhagic shock. Intensive Care Med. 2000 Nov;26(11):1619-23. doi: 10.1007/s001340000669. PMID: 11193267. Öztürk Örmeci G, Yiğit Ö, Eray O. Utility of ETCO2 to predict hemorrhagic shock in multiple trauma patients. Turk J Med Sci. 2022 Feb;52(1):206-215. doi: 10.3906/sag-2103-206. Epub 2022 Feb 22. PMID: 36161601; PMCID: PMC10734833. Wahba RW, Tessler MJ, Béïque F, Kleiman SJ. Changes in PCO2 with acute changes in cardiac index. Can J Anaesth. 1996 Mar;43(3):243-5. doi: 10.1007/BF03011742. PMID: 8829863 Warner KJ, Cuschieri J, Garland B, Carlbom D, Baker D, Copass MK, Jurkovich GJ, Bulger EM. The utility of early end-tidal capnography in monitoring ventilation status after severe injury. J Trauma. 2009 Jan;66(1):26-3

Contributor: Aaron Lessen, MD Educational Pearls: The cause of Alzheimer's disease is multifactorial, but the most widely suspected mechanism is the amyloid cascade hypothesis: Beta-amyloid proteins accumulate in the central nervous system, forming plaques that impair neuronal function. In recent years, advances have led to the development of targeted therapies with monoclonal antibodies. These drugs: Work by degrading amyloid plaques Slow the rate of cognitive decline and disease progression Have major side effects, most notably the development of amyloid-related imaging abnormalities (ARIA) ARIA may present as edema, effusion, or microhemorrhages, which are only detectable on MRI Symptoms can include headache, vertigo, or focal neurologic deficits that mimic stroke For patients presenting to the emergency department with stroke-like symptoms, it is important to consider whether they have a history of Alzheimer's disease and whether they are taking these medications. This guides decisions about imaging and treatment: The work-up may require MRI, which can delay thrombolytic or endovascular therapy in patients with true strokeConversely, treating a patient with ARIA using thrombolytics increases the risk of bleeding and other complications References Ebell MH, Barry HC, Baduni K, Grasso G. Clinically Important Benefits and Harms of Monoclonal Antibodies Targeting Amyloid for the Treatment of Alzheimer Disease: A Systematic Review and Meta-Analysis. Ann Fam Med. 2024 Jan-Feb;22(1):50-62. doi: 10.1370/afm.3050. PMID: 38253509; PMCID: PMC11233076. Ma C, Hong F, Yang S. Amyloidosis in Alzheimer's Disease: Pathogeny, Etiology, and Related Therapeutic Directions. Molecules. 2022 Feb 11;27(4):1210. doi: 10.3390/molecules27041210. PMID: 35209007; PMCID: PMC8876037. Perneczky R, Dom G, Chan A, Falkai P, Bassetti C. Anti-amyloid antibody treatments for Alzheimer's disease. Eur J Neurol. 2024 Feb;31(2):e16049. doi: 10.1111/ene.16049. Epub 2023 Sep 11. PMID: 37697714; PMCID: PMC11235913. Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons and Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

What happens when a febrile infant presents at 61 days old? Are they suddenly low risk for invasive bacterial infections? In this episode, we explore the gray zone of managing febrile infants aged 61–90 days with the help of two new clinical prediction rules from PECARN. Joining us are two powerhouses in pediatric emergency medicine: Dr. Nate Kuppermann and Dr. Paul Aronson, who walk us through their recent study published in Pediatrics. We discuss why prior research has traditionally stopped at 60 days, what the new data shows about risk in this slightly older age group, and how these rules might help guide clinical decision-making. This study fills a long-standing gap—but should we start using the rules now? Tune in for a nuanced discussion on sensitivity, missed cases, practical application, and the future of risk stratification in young infants with fever. What is your practice in terms of work-up of 2-3 month old febrile infants? Will this change what you do? Hit us up social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Executive Vice President and Chief Academic Officer; Director, Children's National Research Institute; Department Chair, Pediatrics, George Washington University School of Medicine and Health Sciences Dr. Paul Aronson, Professor of Pediatrics (Emergency Medicine); Deputy Director, Pediatric Residency Program at Yale University School of Medicine Resources: “Hot” Off the Press: Infant Fever Rule Do I really need to LP a febrile infant with a UTI? Aronson PL, Mahajan P, Meeks HD, Nielsen B, Olsen CS, Casper TC, Grundmeier RW, Kuppermann N; PECARN Registry Working Group. Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. 2025 Sep 1;156(3):e2025071666. doi: 10.1542/peds.2025-071666. PMID: 40854562; PMCID: PMC12432541. Kuppermann N, Dayan PS, Levine DA, Vitale M, Tzimenatos L, Tunik MG, Saunders M, Ruddy RM, Roosevelt G, Rogers AJ, Powell EC, Nigrovic LE, Muenzer J, Linakis JG, Grisanti K, Jaffe DM, Hoyle JD Jr, Greenberg R, Gattu R, Cruz AT, Crain EF, Cohen DM, Brayer A, Borgialli D, Bonsu B, Browne L, Blumberg S, Bennett JE, Atabaki SM, Anders J, Alpern ER, Miller B, Casper TC, Dean JM, Ramilo O, Mahajan P; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019 Apr 1;173(4):342-351. doi: 10.1001/jamapediatrics.2018.5501. PMID: 30776077; PMCID: PMC6450281. Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O'Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5):e2021054063. doi: 10.1542/peds.2021-054063. PMID: 34281996. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Send us a textCritical Congenital Heart Disease and Infant Cancer.Chin S, Lupo PJ, Baer R, Hobbs CA, Chambers CD, Bandoli G.Pediatrics. 2025 Sep 25:e2025072934. doi: 10.1542/peds.2025-072934. Online ahead of print.PMID: 40992753 No abstract available.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

VO2max is trendy right now - but is training for VO2max legit or grift? We dive into the science of VO2max, how to improve it, and if it actually matters for long-distance runners. Thank you to our sponsors:✨ Upstep: Custom orthotics, molded from the comfort of your home. Use code RUNTOTHEFINISH at https://www.upstep.com/?ref=cajmuang for $20 off your purchase. ✨ FlipBelt: Sleek storage options, including no-bounce running belts and shorts. Use code TLF20 at flipbelt.com for 20% off your purchase. In this episode, you will learn:✅ What is your VO2max?✅ What do VO2max numbers actually mean? ✅ How is VO2max calculated?✅ Is your Garmin's VO2max estimate accurate?✅ How much does VO2max matter for performance?✅ How to improve your VO2max✅ Can you improve your performance without changing your VO2max?✅ Is VO2max a health indicator?Field Tests for VO2max:Cooper test: After a 10-20 min warm-up, run as far as you can in 12 minutes. Record distance and enter into this calculator. 1.5-mile run test: After a 10-20 min warm-up, run as fast as you can for 1.5 miles. Record distance and enter into this calculator.Lactate threshold test. After a 10-20 min warm-up, run 30 minutes as fast as you can (self-paced, even effort). Your average pace over the final 20 minutes is your velocity at second LT (60-min race pace) and your average HR over the final 20 min is your LTHR. References:

A breakthrough discovery in the 1970s was the determination of alpha-fetoprotein levels in the serum of pregnant women to detect fetuses with neural tube defects. In the case of high AFP values in maternal serum, amniocentesis was performed to determine the levels of AFP and acetylcholinesterase (AChE) in the amniotic fluid to confirm the diagnosis. Currently, the ACOG states that high-quality, second-trimester fetal anatomy ultrasonography is an appropriate screening test for NTDs where routinely performed for fetal anatomic survey at 18 to 22 weeks. If optimal images of the fetal spine, intracranial anatomy, or anterior abdominal wall are not obtained (eg, fetal position or maternal obesity), MSAFP should be performed to improve detection of NTDs (ACOG Practice Bulletin No. 187: Neural Tube Defects. Committee on Practice Bulletins Obstet Gynecol. 2017). Some clinicians (as we do in our practice) order both fetal anatomy ultrasound and msAFP concurrently. What are the implications when the msAFP is elevated with a normal fetal anatomical survey? Where is this msAFP coming from? Listen in for details.1. ACOG Practice Bulletin No. 187: Neural Tube Defects. Committee on Practice Bulletins Obstet Gynecol. 20172. Pregnancy Outcomes Regarding Maternal Serum AFP Value in Second Trimester Screening. Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Journal of Perinatal Medicine. 2017;45(7):817-820. doi:10.1515/jpm-2016-0101.3. Głowska-Ciemny J, Szmyt K, Kuszerska A, Rzepka R, von Kaisenberg C, Kocyłowski R. Fetal and Placental Causes of Elevated Serum Alpha-Fetoprotein Levels in Pregnant Women. J Clin Med. 2024 Jan 14;13(2):466. doi: 10.3390/jcm13020466. PMID: 38256600; PMCID: PMC10816536.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Join the Behind the Knife Surgical Oncology Team as we discuss the nuances in the work up and management of patients with pheochromocytomas. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center. Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles. Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 2ndYear Surgical Oncology fellow at MD Anderson. Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a General Surgery physician in the United States Air Force station at RAF Lakenheath. Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center. Galen Gist, MD (@gistgalen) is a General Surgery research resident between his second and third year at Brooke Army Medical Center. Learning Objectives: 1)    Review the presentation of patients with pheochromocytomas.  2)    Review the work up of patients with pheochromocytomas.  3)    Review the treatment of patients with pheochromocytomas.  4)    Review the surveillance of patients with pheochromocytomas.  References used in the making of this episode: Patel D. Surgical approach to patients with pheochromocytoma. Gland Surg. 2020;9(1):32-42. doi:10.21037/gs.2019.10.20. PMID: 32206597; PMCID:PMC7082266.   Eisenhofer G, Lenders JW, Siegert G, et al. Plasma methoxytyramine: a novel biomarker of metastatic pheochromocytoma and paraganglioma in relation to established risk factors of tumour size, location and SDHB mutation status. Eur J Cancer. 2012;48(11):1739-1749. doi:10.1016/j.ejca.2011.07.016. PMID:22036874; PMCID: PMC3372624.   Lenders JWM, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet. 2005;366(9486):665-675. doi:10.1016/S0140-6736(05)67139-5.   Vicha A, Musil Z, Pacak K. Genetics of pheochromocytoma and paraganglioma syndromes: new advances and future treatment options. Curr Opin Endocrinol Diabetes Obes. 2013;20(3):186-191. doi:10.1097/MED.0b013e32835fcc45. PMID: 23481210; PMCID: PMC4711348. https://pubmed.ncbi.nlm.nih.gov/23481210/ Dickson PV, Alex GC, Grubbs EG, et al. Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma. Surgery. 2011;150(3):452-458. doi:10.1016/j.surg.2011.07.004. https://pubmed.ncbi.nlm.nih.gov/21878230/ Lei K, Wang X, Yang Z, et al. Comparison of the retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for large (≥6 cm) pheochromocytomas: a single-centre retrospective study. Front Oncol. 2023;13:1043753. doi:10.3389/fonc.2023.1043753. PMID: 36910608; PMCID: PMC9992891. https://pubmed.ncbi.nlm.nih.gov/36910608/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

The only structure of fetal gastrointestinal tract (GIT) which is seen on routine second trimester anomaly scan is the fetal stomach. Under normal conditions, the fetal stomach "bubble" is seen on the left side of the fetal abdomen. This is a normal finding on an ultrasound and indicates the stomach's normal position. There are two functions of the fetal GIT: 1. Propulsive action by peristalsis which takes the swallowed amniotic fluid up to the small bowel; 2. Absorption – the amniotic fluid is absorbed through the fetal small bowel. When the stomach is found prenatally to be located on the right side, it is called dextrogastria. Today in our high-risk prenatal clinic, we encountered a patient whose fetus was found to have this rare condition dextrogastria. Is this an isolated issue? What does this mean for clinical outcomes. Listen in for details.1. Versteegh HP, Adams SD, Boxall S, Burge DM, Stanton MP. Antenatally diagnosed right-sided stomach (dextrogastria): A rare rotational anomaly. J Pediatr Surg. 2016 Feb;51(2):236-9. doi: 10.1016/j.jpedsurg.2015.10.060. Epub 2015 Nov 4. PMID: 26655213.2. A Case Report Of An Isolated Dextrogastria Diagnosed In First Trimester Ultrasound Screening: https://hjog.org/?p=35403. Docx MKF, Steylemans A, Govaert PIsolated dextrogastria in a newbornArchives of Disease in Childhood - Fetal and Neonatal Edition 2015;100:F513.4. https://www.researchgate.net/publication/43349867_Isolated_dextrogastria_A_case_report5. Aziz, S., König, S., Noor, H. et al. Isolated dextrogastria with eventration of right hemidiaphragm and hiatal hernia in an adult male. BMC Gastroenterol 22, 56 (2022). https://doi.org/10.1186/s12876-022-02127-x

All about gymnastics! We interview Dr. Elspeth Hart from Boston Children's on her latest article on Gymnastics Medicine and what to look out for when treating gymnasts in the orthopedic setting. We also highlight recent articles on the urgency of stable SCFE, a lesser-known method for pinning supracondylar humerus fractures, and short versus long leg casting for distal tibia physeal fractures. Your hosts are Tyler McDonald (University of South Alabama), and Stephanie Logterman (Arnold Palmer Hospital for Children), Josh Holt (University of Iowa), and Carter Clement (Manning Family Children's in New Orleans). Music by A. A. Aalto. Gymnastics Upper Extremity Article mentioned: Hart E, Bauer AS, Bae DS. Common upper extremity gymnastics injuries and gymnastic specific return to play protocols. J Pediatr Soc North Am. 2024 Feb 28;6:100016. doi: 10.1016/j.jposna.2024.100016. PMID: 40433250; PMCID: PMC12088353. Link to the non profit Gymnastics Medicine: Education and Research: GymnasticsMedicine.org Link to learn more about the 7th annual Gymnastics Medicine Symposium (use code "Gym15" to save 15% if interested in signing up!): Symposium 2025 - Gymnastics Medicine   References: 1. Hart E, Bair K, Broz J, Griffith K, Herrera-Set A, Lattimore D, Melvin E, Sweeney E. Gymnastics Medicine: A New Subspecialty in Sports Medicine. Curr Sports Med Rep. 2025 May 1;24(5):126-134. doi: 10.1249/JSR.0000000000001249. PMID: 40323057. 2. White AB, Keil LG, Bardsley H, Selberg C, Mansour A, Brooks AC, Manickam R, Mayassi HA, Zhao L, Uchtman M, Whitlock P, Stone J. How Urgent Are Stable SCFEs? A Multisite Retrospective Study of Surgical Timing and Complications Among Patients With Stable Slipped Capital Femoral Epiphysis. J Pediatr Orthop. 2025 Sep 1;45(8):485-491. doi: 10.1097/BPO.0000000000002997. Epub 2025 May 1. PMID: 40314216. 3. Grewal RS, Kitchen BT, Bomar JD, Cidambi EO, Dexter MJ, Edmonds EW, Pring ME, Upasani VV, Wallace CD, Pennock A. Displaced Distal Tibia Physeal Fractures: Short Leg Versus Long Leg Casting-A Prospective Study. J Pediatr Orthop. 2025 Aug 1;45(7):e614-e617. doi: 10.1097/BPO.0000000000002961. Epub 2025 Apr 7. PMID: 40191914. 4. Muto S, Niwa S, Fujihara Y, Ota H, Kumagai H. Comparative Analysis of Postoperative Rotational Malalignment in Pediatric Supracondylar Humerus Fractures: Cross Pinning Versus Lateral Para-olecranon Pinning. J Pediatr Orthop. 2025 Sep 1;45(8):458-465. doi: 10.1097/BPO.0000000000003000. Epub 2025 May 5. PMID: 40323798.

Anne Shirley ist ein Waisenmädchen, das von dem Geschwisterpaar Marilla und Matthew Cuthbert adoptiert wird. In "Anne of Green Gables" wird von ihren Alltagserlebnissen und Schulgeschichten erzählt. Das Buch hat sich seit seiner Veröffentlichung 1908 zur Klassikerin der kanadischen Kinderliteratur entwickelt. Aber kann das Buch auch eine feministische Lesart überstehen? Welche Aspekte finden wir aus heutiger Sicht problematisch? Und würden wir es für Kinder auch heute noch empfehlen?  Quellen:  Edison JK, Clardy C. Lucy Maude Montgomery and Anne of Green Gables: An Early Description of Attention-Deficit/Hyperactivity Disorder. Pediatr Ann. 2017 Jul 1;46(7):e270-e272. doi: 10.3928/19382359-20170614-01. PMID: 28697270. L.M. Montgomery Institute, "Lucy Maud Montgomery: Her Life", https://lmmontgomery.ca/about/l-m-montgomery/ Es folgt Werbung:  "Liebste Freundin!", übersetzt von Andrea Ott und mit einem Nachwort von Adriana Altaras. Kommentierte Gesamtausgabe mit Personenglossar und exklusiver «Leseliste» Jane Austens, erscheint am 1.10.2025. Mehr dazu: https://www.penguin.de/buecher/jane-austen-liebste-freundin-/buch/9783717525875

Suite à une conférence débat menée en janvier 2018 sur l'initiation de la dialyse, le choix de la modalité et la prescription, il a été recommandé le recours à la prise de décision partagée entre le patient et l'équipe de soins pour établir des objectifs de traitement permettant au patient d'atteindre ses propres objectifs de vie et au clinicien de prescrire une dialyse personnalisée de haute qualité1. Mais concrètement, qu'est-ce que la décision médicale partagée (DMP) ? Quels sont les avantages de la DMP et quels sont les moyens possibles pour la développer ?  Le Dr Pierre Housset, néphrologue au Centre Hospitalier Sud Francilien, répond à vos questions.   Invité : Dr Pierre Housset, néphrologue au Centre Hospitalier Sud Francilien Le Dr Housset déclare ne pas avoir de lien d'intérêt en rapport avec le sujet traité.   L'équipe :
 Animation :  Pyramidale Communication Production : Pyramidale Communication   Crédits : Pyramidale Communication, Sonacom   Ce podcast est uniquement destiné à des fins d'information. Si vous souhaitez contacter Baxter pour de plus amples informations ou pour signaler un événement indésirable, veuillez consulter notre site web à l'adresse suivante : https://www.baxter.fr/fr/contact-us   Références : 1. Chan CT et al. Dialysis initiation modality choice, access, and prescription: conclusions from Kidney Disease: Improving Goal Outcomes (KDIGO) Controversies Conference. Kidney International 2019 2. HAS, Patient et professionnels de santé : décider ensemble. 2013 3. Prieto-Velasco M, Quiros P, Remon C, Spanish Group for the Implementation of a Shared Decision Making Process for RRT Choice with Patient Decision Aid Tools (2015) The Concordance between Patients' Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia?. PLOS ONE 10(10): e0138811. 4. Ramer SJ, McCall NN, Robinson-Cohen C, Siew ED, Salat H, Bian A, Stewart TG, El-Sourady MH, Karlekar M, Lipworth L, Ikizler TA, Abdel-Kader K. Health Outcome Priorities of Older Adults with Advanced CKD and Concordance with Their Nephrology Providers' Perceptions. J Am Soc Nephrol. 2018 Dec;29(12):2870-2878. doi: 10.1681/ASN.2018060657. Epub 2018 Nov 1. PMID: 30385652; PMCID: PMC6287864. 5. Mendelssohn DC, et al. A prospective evaluation of renal replacement therapy modality eligibility. Nephrol Dial Transplant. 2009;24(2):555-561. 6. Oliver MJ, et al. Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization. Nephrol Dial Transplant. 2010; 25(8): 2737-2744. 7. de Jong RW, Stel VS, Rahmel A, Murphy M, Vanholder RC, Massy ZA, Jager KJ. Patient-reported factors influencing the choice of their kidney replacement treatment modality. Nephrol Dial Transplant. 2022 Feb 25;37(3):477-488. doi: 10.1093/ndt/gfab059. PMID: 33677544; PMCID: PMC8875472.

In this episode, learn more about Boswellia, which can be used as a supplement for both people and animals.There is research around using boswellia with animals, including:*Siddiqui MZ. Boswellia serrata, a potential antiinflammatory agent: an overview. Indian J Pharm Sci. 2011 May;73(3):255-61. doi: 10.4103/0250-474X.93507. PMID: 22457547; PMCID: PMC3309643.Effects of Boswellia Serrata Supplementation on Ex Vivo Immune Responses in Horses (2018)Miscioscia, E., Shmalberg, J. & Scott, K.C. Measurement of 3-acetyl-11-keto-beta-boswellic acid and 11-keto-beta-boswellic acid in Boswellia serrata Supplements Administered to Dogs. BMC Vet Res 15, 270 (2019). https://doi.org/10.1186/s12917-019-2021-7Interested in learning more about other ayuverdic medicine for animal health? Read this Natural Pet Care Blog post on Ashwagandha!You can get more tips and info by on my Social Media or websites: Facebook Twitter Instagram Pinterest Aloe Vera Health & Skincare For Your Animals

Did you know that C-Section birth is referenced in Shakespeare's Macbeth? Cesarean Section is the most common laparotomy in the world, and yest we are still learning surprising facts about it. This episode we will summarize 2publications which have recently been released. One is from the American Journal of Perinatology (September 2025 ) and the other is from the AJOG (August 2025 ). Does a primary C-section on a laboring uterus have a different risk of PAS in the subsequent pregnancy compared to a non-labored uterus? And what is the percentage of patients who experience “pain” at time of C-section? Listen in for the surprising data.1. Kashani Ligumsky L, Lopian M, Jeong A, Desmond A, Elmalech A, Many A, Martinez G, Krakow D, Afshar Y. Impact of Labor in Primary Cesarean Delivery on Subsequent Risk of Placenta Accreta. Am J Perinatol. 2025 Sep 16. doi: 10.1055/a-2693-8599. Epub ahead of print. PMID: 40957594.2. Somerstein, Rachel. I feel pain, not pressure: a personal and methodological reflection on pain during cesarean delivery. American Journal of Obstetrics & Gynecology, Volume 0, Issue 0 (EPub Ahead of Print)

In our first episode released in both English and Spanish, Drs. Laila Woc-Colburn and Nicholás Ignacio Valdebenito Farías join Dr. José Pablo Díaz Madriz to discuss the role of the pharmacist in antimicrobial stewardship in Latin America. They discuss the need for growth of antimicrobial stewardship programs across Latin America, how pharmacists can expand their roles to support multidisciplinary antimicrobial stewardship teams, and much more!   Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Emerg Infect Dis. 2023 Nov;29(11):2335-44. doi:10.3201/eid2911.230753. PMID:37877573; PMCID:PMC10617342. Antimicrobial Resistance Collaborators. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am. 2023 Aug 8;25:100561. doi:10.1016/j.lana.2023.100561. Erratum in: Lancet Reg Health Am. 2023 Nov 10;28:100632. doi:10.1016/j.lana.2023.100632. PMID:37727594; PMCID:PMC10505822. Fabre V, Secaira C, Cosgrove SE, Lessa FC, Patel TS, Alvarez AA, Anchiraico LM, Del Carmen Bangher M, Barberis MF, Burokas MS, Castañeda X, Colque AM, De Ascencao G, Esquivel C, Ezcurra C, Falleroni LA, Frassone N, Garzón MI, Gomez C, Gonzalez JA, Hernandez D, Laplume D, Lemir CG, Maldonado Briones H, Melgar M, Mesplet F, Martinez G, Pertuz CM, Moreno C, Nemirovsky C, Nuccetelli Y, Palacio B, Sandoval N, Vergara H, Videla H, Villamandos S, Villareal O, Viteri A, Quiros R. Deep dive into gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Latin America. Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S53-S61. doi:10.1093/cid/ciad184. PMID:37406044; PMCID:PMC10321692. Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Birgand G, Poda A, Ahmad R, Singh S, Holmes AH. Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries: a qualitative study. PLoS One. 2019 Jan 16;14(1):e0209847. doi:10.1371/journal.pone.0209847. PMID:30650099; PMCID:PMC6335060. Bavestrello L, Cabello Á, Casanova D. Impact of regulatory measures on antibiotic sales in Chile. Rev Med Chil. 2002 Nov;130(11):1265-72. doi:10.4067/S0034-98872002001100009. ISSN 0034-9887. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica. Rev Panam Salud Publica. 2020;44:e57. doi:10.26633/RPSP.2020.57. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: a retrospective study. J Am Coll Clin Pharm. 2022;5(11):1148-55. doi:10.1002/jac5.1708. Domínguez I, et al. Evaluación del consumo de antimicrobianos en 15 hospitales chilenos: resultados de un trabajo colaborativo, 2013. Rev Chil Infectol. 2016 Jun;33(3):307-12. doi:10.4067/S0716-10182016000300010. ISSN 0716-1018. Ministerio de Salud de Chile. Norma general técnica N°210 para la racionalización del uso de antimicrobianos en la atención clínica. Resolución Exenta N°1146, 2020. Disponible en: https://diprece.minsal.cl/wp-content/uploads/2021/01/RES.-EXENTA-N%C2%B01146-Aprueba-Norma-Gral.-Te%CC%81cnica-N%C2%B00210-para-la-racionalizacio%CC%81n-del-uso-de-antimicrobianos-en-la-Atencio%CC%81n-Cli%CC%81nica_v2.pdf

En nuestro primer episodio publicado tanto en inglés como en español, la Dra. Laila Woc-Colburn y el QF. Nicolás Ignacio Valdebenito Farías se unen al Dr. José Pablo Díaz Madriz para hablar sobre el papel del farmacéutico en los PROA en América Latina. Ellos discuten la necesidad de expandir los PROA en toda la región, cómo los farmacéuticos pueden ampliar sus funciones para apoyar equipos multidisciplinarios dedicados a esta labor, ¡y mucho más! Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Emerg Infect Dis. 2023 Nov;29(11):2335-44. doi:10.3201/eid2911.230753. PMID:37877573; PMCID:PMC10617342. Antimicrobial Resistance Collaborators. The burden of antimicrobial resistance in the Americas in 2019: a cross-country systematic analysis. Lancet Reg Health Am. 2023 Aug 8;25:100561. doi:10.1016/j.lana.2023.100561. Erratum in: Lancet Reg Health Am. 2023 Nov 10;28:100632. doi:10.1016/j.lana.2023.100632. PMID:37727594; PMCID:PMC10505822. Fabre V, Secaira C, Cosgrove SE, Lessa FC, Patel TS, Alvarez AA, Anchiraico LM, Del Carmen Bangher M, Barberis MF, Burokas MS, Castañeda X, Colque AM, De Ascencao G, Esquivel C, Ezcurra C, Falleroni LA, Frassone N, Garzón MI, Gomez C, Gonzalez JA, Hernandez D, Laplume D, Lemir CG, Maldonado Briones H, Melgar M, Mesplet F, Martinez G, Pertuz CM, Moreno C, Nemirovsky C, Nuccetelli Y, Palacio B, Sandoval N, Vergara H, Videla H, Villamandos S, Villareal O, Viteri A, Quiros R. Deep dive into gaps and barriers to implementation of antimicrobial stewardship programs in hospitals in Latin America. Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S53-S61. doi:10.1093/cid/ciad184. PMID:37406044; PMCID:PMC10321692. Charani E, Smith I, Skodvin B, Perozziello A, Lucet JC, Lescure FX, Birgand G, Poda A, Ahmad R, Singh S, Holmes AH. Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries: a qualitative study. PLoS One. 2019 Jan 16;14(1):e0209847. doi:10.1371/journal.pone.0209847. PMID:30650099; PMCID:PMC6335060. Bavestrello L, Cabello Á, Casanova D. Impact of regulatory measures on antibiotic sales in Chile. Rev Med Chil. 2002 Nov;130(11):1265-72. doi:10.4067/S0034-98872002001100009. ISSN 0034-9887. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica. Rev Panam Salud Publica. 2020;44:e57. doi:10.26633/RPSP.2020.57. Díaz-Madriz JP, et al. Impact of a pharmacist-driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: a retrospective study. J Am Coll Clin Pharm. 2022;5(11):1148-55. doi:10.1002/jac5.1708. Domínguez I, et al. Evaluación del consumo de antimicrobianos en 15 hospitales chilenos: resultados de un trabajo colaborativo, 2013. Rev Chil Infectol. 2016 Jun;33(3):307-12. doi:10.4067/S0716-10182016000300010. ISSN 0716-1018. Ministerio de Salud de Chile. Norma general técnica N°210 para la racionalización del uso de antimicrobianos en la atención clínica. Resolución Exenta N°1146, 2020. Disponible en: https://diprece.minsal.cl/wp-content/uploads/2021/01/RES.-EXENTA-N%C2%B01146-Aprueba-Norma-Gral.-Te%CC%81cnica-N%C2%B00210-para-la-racionalizacio%CC%81n-del-uso-de-antimicrobianos-en-la-Atencio%CC%81n-Cli%CC%81nica_v2.pdf

Gravel and mountain bike riders - do you ever wonder why your rides may wreck you? This episode is for you. I'm unpacking what happens to your body when you leave smooth roads behind and enter the world of rocks, roots, vibration, and uneven terrain. I dive deep into: Why gravel/singletrack eats up more energy (vibration, rolling resistance, micro-muscle work) What strength & stability you need (core, grip, posture) to ride harder and recover quicker How to adapt your training and recovery so you don't end up beat, broken, or burnt out Nutrition tips to fuel the rough: protein, electrolytes, and enough carbs Gear & technique hacks: tires, posture, line choice, letting the bike do some of the work Studies referenced if you want to nerd-out:• “Effects of vibration on efficiency in off-road cyclists” (PMID 33948546)• “Strength Training Improves Performance and Pedaling Characteristics in Elite Cyclists” (PMID 24862305)• “Optimizing strength training for running and cycling endurance performance” (PMID 23914932) If you ride gravel or mountain bike, or you want to get into it without paying the price in soreness and fatigue, then this is the episode to guide your next few weeks of training. Check out these related episodes: 221. How to Develop Durability on the Bike 224. How to Finally Stop Bonking Mid-Ride #ShredStrong: Our Fall/Winter Cycle Starts on Monday, November 3, 2025! #ShredStrong is my signature year-round strength and conditioning training program for mountain bikers and gravel cyclists - you can join any time you want, but we're starting the main Fall/Winter cycle in November! Learn more about the program and sign-up HERE!  Do You Want a Coach to Help Make Training & Nutrition Easier and Simpler for You? Hi, it's me.

One course of antibiotics has the power to wipe out certain strains from your microbiome forever. Like everything in health, it's all about dose and right use, but when it comes to antibiotics we are reaching for it too causally without grappling with the real-world consequences. Unfortunately, Martha Carlin was unable to ignore them when it impacted her family in the most fundamental of ways. She has since become a master of gut health, and is serving the public and fight against chronic disease with offerings of the highest quality gut medicine possible. Martha Carlin is a systems thinker, entrepreneur, and founder of The BioCollective, whose journey began when her husband John was diagnosed with Parkinson's disease at age 44. Refusing to accept a future of inevitable decline, she applied her expertise in corporate turnarounds to uncover new approaches to managing and potentially altering the course of chronic disease. Her research  led her to recognize the central role of the gut, which she describes as the “general ledger” of health. In 2014, emerging science confirmed her insights, sparking her to leave her career and begin funding microbiome research at the University of Chicago with Dr. Jack Gilbert. Contact:Website - https://www.marthasquest.com/abouthttps://biotiquest.comJoin us as we explore:How her husband's “old person's disease” diagnosis changed Martha's life foreverHow to deploy specific bacteria strains for specific disease and wellness challenges using Martha's BiotiQuest ranges.How your poop quality and consistency can predict your risk of developing Parkinson's disease.Gut health myth busters - the hidden consequence of antibiotics use, the worst ones and why probiotics at your health shop are not what they seem to be.Mentions:Book - Missing Microbes, https://www.goodreads.com/book/show/17910121-missing-microbes Study - Peng X, Li J, Wu Y, Dai H, Lynn HS, Zhang X. Association of Stool Frequency and Consistency with the Risk of All-Cause and Cause-Specific Mortality among U.S. Adults: Results from NHANES 2005-2010. Healthcare (Basel). 2022 Dec 22;11(1):29. doi: 10.3390/healthcare11010029. PMID: 36611489; PMCID: PMC9818668.Person - Dr Hans Vink, https://glycocalyx.com/pages/about-usSupport the showFollow Steve's socials: Instagram | LinkedIn | YouTube | Facebook | Twitter | TikTokSupport the show on Patreon:As much as we love doing it, there are costs involved and any contribution will allow us to keep going and keep finding the best guests in the world to share their health expertise with you. I'd be grateful and feel so blessed by your support: https://www.patreon.com/MadeToThriveShowSend me a WhatsApp to +27 64 871 0308. Disclaimer: Please see the link for our disclaimer policy for all of our content: https://madetothrive.co.za/terms-and-conditions-and-privacy-policy/

Most doctors dream about leaving the ER grind, but here's what's remarkable: Dr. Nico Grundmann didn't just escape - he built something that's actually changing how we think about mental healthcare at scale.In this conversation, Sam sits down with Dr. Grundmann, an emergency physician who took his systems-thinking background and created something unprecedented: a five-location ketamine practice that's generating the kind of data insurance companies actually pay attention to. We're talking about going from solo practitioner to managing 30 team members while maintaining the clinical rigor that makes this work sustainable.What makes this conversation essential listening? Dr. Grundmann's approach shows exactly how individual practices can drive policy-level change - but it requires thinking beyond your patient panel to the broader healthcare system. His story proves that with the right framework, you can build something that's both profitable and positioned to influence national coverage decisions.If you've ever wondered how to scale beyond a single clinic without losing clinical quality, or if you're curious about what it really takes to collect data that insurance companies respect, this conversation will give you the roadmap you need.What You'll Learn in This Episode

Contributor: Aaron Lessen, MD Educational Pearls: What is a Nursemaid's Elbow? A condition in which an elbow gets partially pulled out of place (a radial head subluxation) Usually happens in kids under 5 because the ligaments around their elbow are still loose. A common situation is when an adult pulls a child up by the hand or swings them by the arms. The sudden tug causes the radius to slip out of its normal spot at the elbow joint. How are they identified? These don't normally need an xray The child will often hold their arm close to their side and refuse to use it There's usually no swelling or obvious deformity. Treatment? Reduce the radial head subluxation. There are two possible techniques: Flexion and supination. Start with the arm extended and pronated. Then supinate the forearm. Then bend the elbow up all the way. Hyper-pronation. One hand stabilizes just above the child's elbow, the other holds the wrist. Start with the arm extended. Hyperpronate the forearm. Listen/feel for a click The child is normally back to normal quickly, if not get the xray Which is better? Hyperpronation (Aksel, 2025) 10% first attempt failure rate Flexion-pronation has a 25% first attempt failure rate References Aksel G, Küka B, İslam MM, Demirkapı F, Öztürk İ, İşlek OM, Ademoğlu E, Eroğlu SE, Satıcı MO, Özdemir S. Comparison of supination/flexion maneuver to hyperpronation maneuver in the reduction of radial head subluxations: A randomized clinical trial. Am J Emerg Med. 2025 Feb;88:29-33. doi: 10.1016/j.ajem.2024.11.026. Epub 2024 Nov 18. PMID: 39579408. Ulici A, Herdea A, Carp M, Nahoi CA, Tevanov I. Nursemaid's Elbow - Supination-flexion Technique Versus Hyperpronation/forced Pronation: Randomized Clinical Study. Indian J Orthop. 2019 Jan-Feb;53(1):117-121. doi: 10.4103/ortho.IJOrtho_442_17. PMID: 30905991; PMCID: PMC6394198. Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

In this episode, we review the newly published 2025 ACC/AHA hypertension guidelines. Key Concepts Instead of the Pooled Cohort Equations (PCE) from 2013, the 2025 hypertension guidelines recommend a new risk equation called PREVENT, which incorporates new risk factors and does not include race as part of the risk calculation. The guidelines recommend starting two antihypertensive medications for initial therapy in stage II hypertension and one antihypertensive medication for stage I hypertension. The guidelines no longer recommend specific first-line therapies for black patients. Instead, all patients without compelling indications should be initiated on a thiazide, ACE inhibitor, ARB, or dihydropyridine calcium channel blocker regardless of race/ethnicity. All patients should have a blood pressure goal of < 130/80 mmHg. Some patients may consider a more stringent goal of < 120/80 if they have diabetes or are at a higher risk of future ASCVD events. References Jones DW, Ferdinand KC, Taler SJ, Johnson HM, Shimbo D, Abdalla M, Altieri MM, Bansal N, Bello NA, Bress AP, Carter J, Cohen JB, Collins KJ, Commodore-Mensah Y, Davis LL, Egan B, Khan SS, Lloyd-Jones DM, Melnyk BM, Mistry EA, Ogunniyi MO, Schott SL, Smith SC Jr, Talbot AW, Vongpatanasin W, Watson KE, Whelton PK, Williamson JD. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025 Aug 14. doi: 10.1161/CIR.0000000000001356. Epub ahead of print. PMID: 40811497.

Dive into the second half of our envenomation series! Dr. Jonathan Ford, a UC Davis Medical Toxicologist and Professor of Emergency Medicine, returns to the podcast to tackle scorpions and spiders. We're going beyond the basics to discuss the "why" and "how" of these bites and stings. Learn about the neurotoxic effects of bark scorpion venom and the life-threatening airway risks. Explore the mechanism behind black widow bites that leads to intense pain and spasms, and the crucial role of antivenom in severe cases. Plus, we're setting the record straight on a common myth—the brown recluse—and the proper supportive care for its nasty bite. Join us to discover the latest evidence-based approaches that could change how you manage your next bite or sting. Have you had a patient with a serious or challenging envenomation?  How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Quan D. North American poisonous bites and stings. Crit Care Clin. 2012 Oct;28(4):633-59. doi: 10.1016/j.ccc.2012.07.010. PMID: 22998994. Levine M, Friedman N. Terrestrial envenomations in pediatric patients: identification and management in the emergency department. Pediatr Emerg Med Pract. 2021 Sep;18(9):1-24. Epub 2021 Sep 2. PMID: 34403224.. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

I was blown away by the myriad of health benefits of a tiny molecule composed of 2 hydrogens (H2) after the conversation with today's guest. I dove into the research myself and saw that the literature has described the anti-oxidative, anti-inflammatory and anti-apoptotic properties of molecular hydrogen. The most common methods of administration are inhalation and ingestion of the dissolved molecule in water. Research also shows that endogenous H2 is produced in the intestines, and can be stimulated by dietary intake of turmeric, for example (another win for herbs!). Struggling to find answers and overcome extreme depression due to his compromised immune system, tumors, autoimmune issues, gut health, arthritis, wheelchair-bound immobility, and a very serious heart condition, Greg Hman began his own journey to heal himself and discovered hydrogen along the way. Studying the complex compound for four years, he implemented it into his health regimen and reversed his health challenges. Greg discusses the endless health benefits of hydrogen including longevity, gut health and improving chronic health issues. Greg also talks about how it helps support the body through a variety of stressors including: EMF radiation, skincare, tumors, hormone imbalances and COVID-19. Connect with Greg via: Email:support@holyhydrogen.com Website: Holy Hydrogen FB: Holy Hydrogen IG: @holy.hydrogen YT: https://www.youtube.com/@UPRISING144K Works Cited: Ge L, Yang M, Yang NN, Yin XX, Song WG. Molecular hydrogen: a preventive and therapeutic medical gas for various diseases. Oncotarget. 2017 Sep 21;8(60):102653-102673. doi: 10.18632/oncotarget.21130. PMID: 29254278; PMCID: PMC5731988. Visit https://marinabuksov.com for more holistic content. Music from https://www.purple-planet.com. Disclaimer: Statements herein have not been evaluated by the Food and Drug Administration. Products listed are not intended to diagnose, treat, cure, or prevent any diseases.

In 2023, we released 2 episodes on obstructive sleep apnea (OSA) and adverse pregnancy. Now, on September 16, 2025, a new publication from JAMA Network Open adds more insights to disturbed sleep and adverse pregnancy outcomes. How does insomnia affect pregnancy? And is there any data on night shift work and its altered circadian rhythms on adverse pregnancy outcomes? Listen in for details. 1. Ross N, Baer RJ, Oltman SP, et al. Ischemic Placental Disease and Severe Morbidity in Pregnant Patients With Sleep Disorders. JAMA Netw Open. 2025;8(9):e2532189. doi:10.1001/jamanetworkopen.2025.321892. Cai C, Vandermeer B, Khurana R, et al. The Impact of Occupational Shift Work and Working hours during Pregnancy on Health Outcomes: a systematic Review and Meta-Analysis.American Journal of Obstetrics and Gynecology. 2019;221(6):563-576. doi:10.1016/j.ajog.2019.06.051.3. Dominguez JE, Cantrell S, Habib AS, Izci-Balserak B, Lockhart E, Louis JM, Miskovic A, Nadler JW, Nagappa M, O'Brien LM, Won C, Bourjeily G. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy. Obstet Gynecol. 2023 Aug 1;142(2):403-423. doi: 10.1097/AOG.0000000000005261. Epub 2023 Jul 5. PMID: 37411038; PMCID: PMC10351908.4. Kader M, Bigert C, Andersson T, et al . Shift and Night Work During Pregnancy and Preterm Birth-a Cohort Study of Swedish Health Care Employees. International Journal of Epidemiology. 2022;50(6):1864-1874. doi:10.1093/ije/dyab135.STRONG COFFEE PROMO: 20% Off Strong Coffee Companyhttps://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Silvia and Rodrigo are joined by Dr Ray Wang, Director of the multidisciplinary Foundation of Caring Lysosomal Storage Disorder Program at the Children's Hospital of Orange County. Silvia asks Dr Wang and Rodrigo (who also happens to be a researcher in this field) about cutting-edge advances in LSD research: from base editing in Pompe disease and patient-specific in vivo gene editing, to new biomarkers and scoring systems in Gaucher disease, insights into lipid dysregulation across lysosomal storage disorders, and the first clinical trial of anakinra in Sanfilippo syndrome. Papers discussed include: Christensen CL, et al Base editing rescues acid α-glucosidase function in infantile-onset Pompe disease patient-derived cells. Mol Ther Nucleic Acids. 2024 May 21;35(2):102220. doi: 10.1016/j.omtn.2024.102220. PMID: 38948331; PMCID: PMC11214518. Starosta RT, et al Predicting liver fibrosis in Gaucher disease: Investigation of contributors and development of a clinically applicable Gaucher liver fibrosis score. Mol Genet Metab. 2025 Feb;144(2):109010. doi: 10.1016/j.ymgme.2025.109010. Epub 2025 Jan 3. PMID: 39788861. Kell P, et al Secondary accumulation of lyso-platelet activating factors in lysosomal storage diseases. Mol Genet Metab. 2025 Jun 17;145(4):109180. doi: 10.1016/j.ymgme.2025.109180. Polgreen LE, et al Anakinra in Sanfilippo syndrome: a phase 1/2 trial. Nat Med. 2024 Sep;30(9):2473-2479. doi: 10.1038/s41591-024-03079-3. Epub 2024 Jun 21. Erratum in: Nat Med. 2024 Sep;30(9):2693. doi: 10.1038/s41591-024-03207-z. Musunuru K, et al Patient-Specific In Vivo Gene Editing to Treat a Rare Genetic Disease. N Engl J Med. 2025 Jun 12;392(22):2235-2243. doi: 10.1056/NEJMoa2504747.

Contributor: Ricky Dhaliwal, MD Educational Pearls: Angioedema in anaphylaxis Histamine and mast cell-mediated pathway Treatment: First line: epinephrine for vasoconstriction and bronchodilation Second line: H1 and H2 antihistamines such as Benadryl and famotidine ACE inhibitor-induced angioedema Different pathway from anaphylaxis ACE inhibitor-induced angioedema is mediated by bradykinins Therefore, anaphylaxis medications are not beneficial in patients with ACE inhibitor-induced angioedema Leading cause of drug-induced angioedema in the US Patients most commonly present with swelling of the lips, tongue, or face Treatment: Airway management: varies depending on the severity and progression of the presentation If awake nasointubation is required, LMX is a 5% lidocaine water-soluble solution that provides anesthesia to the oropharynx Medications: Icatibant is a synthetic bradykinin B2-receptor antagonist that can be used in acute treatment Tranexamic acid (TXA) inhibits the plasmin-dependent formation of bradykinin, but the data on this treatment are mixed and limited Fresh frozen plasma (FFP) is thought to degrade high levels of bradykinin with subsequent resolution of angioedema Discontinue ACE inhibitor References Bork K, Wulff K, Hardt J, Witzke G, Staubach P. Hereditary angioedema caused by missense mutations in the factor XII gene: clinical features, trigger factors, and therapy. J Allergy Clin Immunol. 2009 Jul;124(1):129-34. doi: 10.1016/j.jaci.2009.03.038. Epub 2009 May 27. PMID: 19477491. Bova M, Guilarte M, Sala-Cunill A, Borrelli P, Rizzelli GM, Zanichelli A. Treatment of ACEI-related angioedema with icatibant: a case series. Intern Emerg Med. 2015 Apr;10(3):345-50. doi: 10.1007/s11739-015-1205-9. Epub 2015 Feb 10. PMID: 25666515. Karim MY, Masood A. Fresh-frozen plasma as a treatment for life-threatening ACE-inhibitor angioedema. J Allergy Clin Immunol. 2002 Feb;109(2):370-1. doi: 10.1067/mai.2002.121313. PMID: 11842313. Pathak GN, Truong TM, Chakraborty A, Rao B, Monteleone C. Tranexamic acid for angiotensin-converting enzyme inhibitor-induced angioedema. Clin Exp Emerg Med. 2024 Mar;11(1):94-99. doi: 10.15441/ceem.23.051. Epub 2023 Aug 1. PMID: 37525579; PMCID: PMC11009700. Simons FE. First-aid treatment of anaphylaxis to food: focus on epinephrine. J Allergy Clin Immunol. 2004 May;113(5):837-44. doi: 10.1016/j.jaci.2004.01.769. Erratum in: J Allergy Clin Immunol. 2004 Jun;113(6):1039. Dosage error in article text. PMID: 15131564. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Learning Objectives:By the end of this two-part series, listeners should be able to discuss:The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).Patient populations most likely to benefit from HFPV.Key published evidence that informs our use of HFPV in pediatric critical care.An expert approach to managing a patient with HFPV.Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.About our Guest: Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children's Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance. References:Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CEDominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Send us a textDopamine versus epinephrine for neonatal septic shock: an open labeled, randomized controlled trial. Singh G, Bhaskar V, Batra P, Gupta P.J Perinatol. 2025 Aug 28. doi: 10.1038/s41372-025-02399-7. Online ahead of print.PMID: 40877444EBNEO Commentary: Review of the 'Norepinephrine Versus Dopamine for Septic Shock in Neonates: A Randomised Controlled Trial'. Altit G.Acta Paediatr. 2025 Jul 23. doi: 10.1111/apa.70241. Online ahead of print.PMID: 40698742 No abstract available.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a textCord red blood cell transfusions for severe retinopathy in preterm neonates in Italy: a multicenter randomized controlled trial. Teofili L, Papacci P, Pellegrino C, Dani C, Cresi F, Remaschi G, Ansaldi G, Giannantonio C, Campagnoli MF, Vania B, Fabbri M, de Vera d' Aragona RP, Molisso A, Beccastrini E, Dragonetti A, Pasciuto T, Gabbriellini S, Baroni S, Serrao F, Purcaro V, Raffaeli G, Villa S, Prati D, Mondello I, Falcone A, Patti ML, Boggini T, Bergamaschi P, Lepore D, Franco FGS, Orazi L, Mozzetta I, Baldascino A, Valentini CG, Locatelli E, Albiani R, Besso FG, Cantone GV, Coscia A, Trimarchi A, Cavallaro G, Ghirardello S, Vento G.EClinicalMedicine. 2025 Aug 13;87:103426. doi: 10.1016/j.eclinm.2025.103426. eCollection 2025 Sep.PMID: 40838199 Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Husband-and-wife team William Firth Wells and Mildred Weeks Wells conducted research that had the potential to make a big difference in the safety of indoor air. But it didn’t really have a significant impact on public health. Research: Associated Press. “Super-Oyster Is On its Way to Dinner Table Bigger and Better Bivalve Sports Pedigree.” 3/13/1927. https://www.loc.gov/resource/sn84020064/1927-03-13/ed-1/?sp=14 “Brought Back to Texas.” The Houston Semi-Weekly Post. 12/26/1889. https://www.newspapers.com/image/1196039760/ Decatur Daily Review. “Scientists Fight Flu Germs with Violet Ray.” 7/30/1936. https://www.newspapers.com/image/94335504/ Evening Star. “Scientific Trap-shooter.” 6/26/1937. https://www.loc.gov/resource/sn83045462/1937-06-26/ed-1/?sp=7&q=William+Firth+Wells&r=0.668,0.557,0.438,0.158,0 Fair, Gordon M. and William Weeks Wells. “Method and Apparatus for Preventing Infection.” U.S. Patent 2,198,867. https://ppubs.uspto.gov/api/pdf/downloadPdf/2198867 Hall, Dominic. “New Center for the History of Medicine Artifact - Wells Air Centrifuge.” Harvard Countway Library. https://countway.harvard.edu/news/new-center-history-medicine-artifact-wells-air-centrifuge “Incubator Is Now Oyster Nurse.” Washington Times. 10/1/1925. https://www.loc.gov/resource/sn84026749/1925-10-01/ed-1/?sp=12 Lewis, Carol Sutton. “Mildred Weeks Wells’s Work on Airborne Transmission Could Have Saved Many Lives—If the Scientific Establishment Listened.” Lost Women of Science Podcast. Scientific American. 5/22/2025. https://www.scientificamerican.com/article/a-public-health-researcher-and-her-engineer-husband-found-how-diseases-can/ Library and Archives Team. “William Firth Wells and Mildred Weeks Wells.” Washington College. https://www.washcoll.edu/people_departments/offices/miller-library/archives-special-collections/archives-blog/Wells%20papers.php Molenti, Megan. “The 60-Year-Old Scientific Screwup That Helped Covid Kill.” Wired. 5/13/2021. https://www.wired.com/story/the-teeny-tiny-scientific-screwup-that-helped-covid-kill/ Perkins JE, Bahlke AM, Silverman HF. Effect of Ultra-violet Irradiation of Classrooms on Spread of Measles in Large Rural Central Schools Preliminary Report. Am J Public Health Nations Health. 1947 May;37(5):529-37. PMID: 18016521; PMCID: PMC1623610. Randall, Katherine and Ewing, E. Thomas and Marr, Linsey and Jimenez, Jose and Bourouiba, Lydia, How Did We Get Here: What Are Droplets and Aerosols and How Far Do They Go? A Historical Perspective on the Transmission of Respiratory Infectious Diseases (April 15, 2021). Available at SSRN: https://ssrn.com/abstract=3829873 Riley, Richard L. “What Nobody Needs to Know About Airborne Infection.” American Journal of Respiratory and Critical Care Medicine. Volume 163, Issue 1. https://www.atsjournals.org/doi/10.1164/ajrccm.163.1.hh11-00 Simon, Clea. “Did a socially awkward scientist set back airborne disease control?” The Harvard Gazette. 3/7/2025. https://news.harvard.edu/gazette/story/2025/03/did-a-socially-awkward-scientist-set-back-airborne-disease-control/ “Texas State News.” McKinney Weekly Democrat-Gazette. 4/17/1890. https://www.newspapers.com/image/65385350/ WELLS MW, HOLLA WA. VENTILATION IN THE FLOW OF MEASLES AND CHICKENPOX THROUGH A COMMUNITY: Progress Report, Jan. 1, 1946 to June 15, 1949, Airborne Infection Study, Westchester County Department of Health. JAMA. 1950;142(17):1337–1344. doi:10.1001/jama.1950.02910350007004 WELLS MW. VENTILATION IN THE SPREAD OF CHICKENPOX AND MEASLES WITHIN SCHOOL ROOMS. JAMA. 1945;129(3):197–200. doi:10.1001/jama.1945.02860370019006 WELLS WF, WELLS MW. AIR-BORNE INFECTION. JAMA. 1936;107(21):1698–1703. doi:10.1001/jama.1936.02770470016004 WELLS WF, WELLS MW. AIR-BORNE INFECTION: SANITARY CONTROL. JAMA. 1936;107(22):1805–1809. doi:10.1001/jama.1936.02770480037010 Wells, W F, and M W Wells. “Measurement of Sanitary Ventilation.” American journal of public health and the nation's health vol. 28,3 (1938): 343-50. doi:10.2105/ajph.28.3.343 Wells, William Firth and Gordon Maskew Fair. Viability of B. coli Exposed to Ultra-Violet Radiation in Air.Science82,280-281(1935).DOI:10.1126/science.82.2125.280.b Wells, William Firth and Mildred Weeks Wells. Measurement of Sanitary Ventilation American Journal of Public Health and the Nations Health 28, 343_350, https://doi.org/10.2105/AJPH.28.3.343 Zimmer, Carl. “Air-Borne: The Hidden History of the Life We Breathe.” Dutton. 2025. See omnystudio.com/listener for privacy information.

This is a fascinating podcast episode from Dr. Lipid himself on desmosterol.  What is it?  How do we measure it?  Why should we care? Pharmacists are well-positioned to guide patients in understanding the role of desmosterol, how medications may influence its levels, the options for measuring it, and the steps to take if levels are too high or too low. Dr. Thomas Dayspring: linkedin.com/in/thomas-dayspring-md-facp-fnla-3aaa876 or @DrLipid on X  Tamara Ruggles, PharmD: linkedin.com/in/tamara-ruggles-491882251 Resource on lipids recommended by Dr. Dayspring: https://familyheart.org/ Wages PA, Kim HH, Korade Z, Porter NA. Identification and characterization of prescription drugs that change levels of 7-dehydrocholesterol and desmosterol. J Lipid Res. 2018 Oct;59(10):1916-1926. doi: 10.1194/jlr.M086991. Epub 2018 Aug 7. PMID: 30087204; PMCID: PMC6168312.  Available at:  https://pubmed.ncbi.nlm.nih.gov/30087204/  The Geriatric Pharmacy Focus podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Welcome to the Olink® Proteomics in Proximity podcast!  Below are some useful resources mentioned in this episode:  Olink tools and software·       Olink® Explore HT, Olink's most advanced solution for high-throughput biomarker discovery, measuring 5400+ proteins simultaneously with a streamlined workflow and industry-leading specificity: https://olink.com/products-services/exploreht/  UK Biobank Pharma Proteomics Project (UKB-PPP), one of the world's largest scientific studies of blood protein biomarkers conducted to date, https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/news/uk-biobank-launches-one-of-the-largest-scientific-studies  World Health Organization (2003). Adherence to long-term therapies: evidence for action (PDF). Geneva: World Health Organisation. ISBN 978-92-4-154599-0 Research articles and news·       Thermo Fisher Scientific's Olink Platform Selected for World's Largest Human Proteome Studyhttps://ir.thermofisher.com/investors/news-events/news/news-details/2025/Thermo-Fisher-Scientifics-Olink-Platform-Selected-for-Worlds-Largest-Human-Proteome-Study/default.aspx·       Hamilton Se-Hwee Oh et al 2025. Plasma proteomics links brain and immune system aging with healthspan and longevityhttps://www.nature.com/articles/s41591-025-03798-1. Nature Medicine (2025)·       Song, Y., Abuduaini, B., Yang, X. et al. Identification of inflammatory protein biomarkers for predicting the different subtype of adult with tuberculosis: an Olink proteomic study. Inflamm. Res. 74, 60 (2025). https://doi.org/10.1007/s00011-025-02020-9·       Ferhan Qureshi et al 2023. Analytical validation of a multi-protein, serum-based assay for disease activity assessments in multiple sclerosis. Proteomics clinical application 2023·       Dhindsa, R.S., Burren, O.S., Sun, B.B. et al. Rare variant associations with plasma protein levels in the UK Biobank. 2023 Nature, DOI: 10.1038/s41586-023-06547-xhttps://www.nature.com/articles/s41586-023-06547-x·       Sun, B.B., Chiou, J., Traylor, M. et al.  Plasma proteomic associations with genetics and health in the UK Biobank. 2023 Nature, DOI: 10.1038/s41586-023-06592-6 https://www.nature.com/articles/s41586-023-06592-6 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac495/6676779·       Eldjarn GH, et al. Large-scale plasma proteomics comparisons through genetics and disease associations. Nature. 2023 Oct;622(7982):348-358. doi: 10.1038/s41586-023-06563-xhttps://www.nature.com/articles/s41586-023-06563-x#Sec44·        Carrasco-Zanini et al 2024 Proteomic prediction of common and rare diseases. https://www.nature.com/articles/s41591-024-03142-z . NatureMedicine volume 30,  pages2489–2498 (2024)·       Watanabe K, Wilmanski T, Diener C, et al. Multiomic signatures of body mass index identify heterogeneous health phenotypes and responses to a lifestyle intervention.https://www.nature.com/articles/s41591-023-02248-0·       Petrera A, von Toerne C, Behlr J, et al. Multiplatform Approach for Plasma Proteomics: Complementarity of Olink Proximity Extension Assay Technology to Mass Spectrometry-Based Protein Profiling. (2020) Journal of Proteome Research, https://pubs.acs.org/doi/pdf/10.1021/acs.jproteome.0c00641·       Multicenter Collaborative Study to Optimize Mass Spectrometry Workflows of Clinical Specimens. Kardell O, von Toerne C, Merl-Pham J, König AC, Blindert M, Barth TK, Mergner J, Ludwig C, Tüshaus J, Eckert S, Müller SA, Breimann S, Giesbertz P, Bernhardt AM, Schweizer L, Albrecht V, Teupser D, Imhof A, Kuster B, Lichtenthaler SF, Mann M, Cox J, Hauck SM. J Proteome Res. 2024 Jan 5;23(1):117-129. doi: 10.1021/acs.jproteome.3c00473. Epub 2023 Nov 28. PMID: 38015820 https://pubs.acs.org/doi/10.1021/acs.jproteome.3c00473·       Wei, S., Shen, R., Lu, X. et al. Integrative multi-omics investigation of sleep apnea: gut microbiome metabolomics, proteomics and phenome-wide association study. Nutr Metab (Lond) 22, 57 (2025). https://doi.org/10.1186/s12986-025-00925-0·       Liu, L., Li, M., Qin, Y. et al. Childhood obesity and insulin resistance is correlated with gut microbiome serum protein: an integrated metagenomic and proteomic analysis. Sci Rep 15, 21436 (2025). https://doi.org/10.1038/s41598-025-07357-z·       Zhang, Xiaotao et al.Modulating a prebiotic food source influences inflammation and immune-regulating gut microbes and metabolites: insights from the BE GONE trial. eBioMedicine, Volume 98, 104873 (2023.).  10.1016/j.ebiom.2023.104873·      &nb...

Learning Objectives:By the end of this two-part series, listeners should be able to discuss:The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).Patient populations most likely to benefit from HFPV.Key published evidence that informs our use of HFPV in pediatric critical care.An expert approach to managing a patient with HFPV.Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.About our Guest: Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children's Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance. References:Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CEDominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

In this Complex Care Journal Club podcast episode, Ms. Kathryn Knight and Dr. Brian K. Jordan discuss a national survey of families of children with medical complexity on access to home health nursing. They describe the impact of the nursing shortage on families, development of a nonprofit resource that facilitates connections between families and home nursing, and outline next steps from this work. Learn more about Hello Nurze: www.hellonurze.com Find additional details about the F.A.C.E.S. Project: www.hellonurze.com/p/faces-project SPEAKERS Kathryn Knight, BBA Co-Founder & Executive Director, Hello Nurze Brian K. Jordan, MD, PhD Associate Professor Oregon Health & Science University HOST Emily J. Goodwin, MD Clinical Associate Professor of Pediatrics University of Missouri Kansas City School of Medicine Pediatrician, General Academic Pediatrics Beacon Program Children's Mercy Kansas City DATE Initial publication date: September 8, 2025. JOURNAL CLUB ARTICLE Knight K, Knight G, Jordan BK. The Impact of the Lack of Access to Home Health Nursing on Families of Children with Medical Complexity in the United States. Home Healthc Now. 2025 Jul-Aug 01;43(4):213-220. doi: 10.1097/NHH.0000000000001356. Epub 2025 Jul 7. PMID: 40619624. OTHER ARTICLES REFERENCED Baker CD, Martin S, Thrasher J, Moore HM, Baker J, Abman SH, Gien J. A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children. Pediatrics. 2016 Apr;137(4):e20150637. doi: 10.1542/peds.2015-0637. Epub 2016 Mar 10. PMID: 26966133; PMCID: PMC4811306. Hello Nurze. Connecting families and in-home nurses. Accessed August 27, 2025. https://www.hellonurze.com Moore PE, Boyer D, O'Connor MG, Baker CD, Rettig JS, Sterni L, Halbower A, Wilson KC, Thomson CC. Pediatric Chronic Home Invasive Ventilation. Ann Am Thorac Soc. 2016 Jul;13(7):1170-2. doi: 10.1513/AnnalsATS.201603-196CME. PMID: 27388405; PMCID: PMC5462000. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/87x9cmw5xfnkkt74v5g5pv3/Jordan_and_Knight_Final_Transcript__9-5-25‌ Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Knight K, Jordan BK, Goodwin EJ. From Crisis to Connection: Matching Families with Home Nursing Support in Complex Care. 09/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/from-crisis-to-connection-matching-families-with-home-nursing-support-in-complex-care.

Dr. Lindsay Andras from Children's Hospital of Los Angeles joins the show to discuss her recent randomized control trial comparing outcomes of functional bracing and spica casting for pediatric femoral shaft fractures. Drs. Andras and co-author Dr. Julia Sanders share insights from their experience conducting a randomized control trial and the pearls and pitfalls of implementing the functional brace. The lightning round highlights articles on spinal involvement in hereditary multiple osteochondromas, outcomes of pediatric multi-ligamentous knee injuries, and the impact of Pavlik harness treatment on breastfeeding efficacy.   Your hosts are Will Morris (Scottish Rite for Children in Dallas), Julia Sanders (Children's Hospital of Colorado), Tyler McDonald (University of South Alabama), and Steph Logterman (Arnold Palmer Hospital for Children). Music by A. A. Aalto.   Disclosure: Drs. Lindsay Andras and Julia Sanders each receive royalties from Orthopediatrics who produce a version of the fracture brace discussed in this episode.   References: 1. Andras LM, Sanders JS, Phan TN, Purtell SR, Gasca J, Wren TAL, Sim AT, Skaggs D, Kramer A, Chavez M, Kay R. A Prospective, Randomized Comparison of Functional Bracing and Spica Casting for Femoral Fractures Showed Equivalent Early Outcomes. J Bone Joint Surg Am. 2025 Jun 26;107(16):1769-1776. doi: 10.2106/JBJS.24.01081. PMID: 40570075. 2. Casey VF, Chandler CC, Graham GD, Frick SL. Dynamic Femur Fracture Brace vs Hip Spica Cast for Pediatric Femoral Shaft Fractures: A Retrospective Comparative Cohort Study. J Pediatr Soc North Am. 2025 May 23;12:100203. doi: 10.1016/j.jposna.2025.100203. PMID: 40704087; PMCID: PMC12284357. 3. Lang PJ, Feroe A, Franco H, Hussain ZB, Tepolt FA, Kocher MS. Outcomes of Operative Management of Multi-Ligament Knee Injuries in an Adolescent Population: A Retrospective Case Series. J Pediatr Soc North Am. 2024 Feb 5;5(4):742. doi: 10.55275/JPOSNA-2023-742. PMID: 40432936; PMCID: PMC12088175. 4. Bram JT, Tracey OC, Trotzky Z, Jones RH, Jochl O, Cirrincione PM, Nichols E, Dodwell ER, Scher DM, Doyle SH, Sink EL. Pavlik Harness Treatment for Infantile Hip Dysplasia Lowers Breastfeeding Self-efficacy. J Pediatr Orthop. 2025 Sep 1;45(8):e701-e705. doi: 10.1097/BPO.0000000000002976. Epub 2025 Apr 21. PMID: 40256838. 5. Legler J, Benaroch LR, Pirshahid AA, Serhan O, Cheng D, Bartley D, Carey T, Rasoulinejad P, Singh S, Thornley P. Rate of Spinal Osteochondromas Diagnosed in Pediatric Patients With Hereditary Multiple Osteochondromas: A Systematic Review and Meta-Analysis. J Pediatr Orthop. 2025 Sep 1;45(8):e718-e723. doi: 10.1097/BPO.0000000000002975. Epub 2025 Apr 23. PMID: 40266849.

Learn how to sharpen your pediatric intubation skills and make evidence-based decisions at the bedside. Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania expertly dissect the nuances of selecting optimal induction agents for critically ill children in the PICU. Through engaging, real-world case scenarios, our hosts guide you through drug choices in complex situations such as cardiogenic shock, septic shock, and elevated intracranial pressure—always prioritizing hemodynamic stability and patient safety. Gain valuable insights into the advantages, limitations, and clinical pearls of agents like propofol, fentanyl, ketamine, and midazolam, along with practical strategies for rapid sequence intubation, neuromuscular blockade, and individualized patient care. Don't miss this high-yield discussion, packed with actionable knowledge!Show Highlights:Induction agents for endotracheal intubation in critically ill childrenClinical scenarios highlighting optimal choices of induction agents and neuromuscular blockersImportance of maintaining hemodynamic stability during intubationPharmacology and clinical considerations of various induction agents (e.g., propofol, ketamine, fentanyl, etomidate)Use of neuromuscular blocking agents (NMBAs) in pediatric intubationDifferences between depolarizing and non-depolarizing neuromuscular blockersRisks associated with specific induction agents in patients with cardiac dysfunction or septic shockModified rapid sequence intubation (RSI) techniques for unstable patientsKey takeaways for managing critically ill pediatric patients requiring intubationPractical tips for optimizing intubation conditions and minimizing complicationsReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care 6th Edition. Chapters 127 - 135, Pages 1510 - 1610Hendrix JM, Regunath H. Intubation Endotracheal Tube Medications. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459276/Agrawal, Dewesh. Rapid sequence intubation (RSI) in children for emergency medicine: Medications for sedation and paralysis. UpToDate. Last updated Dec 4, 2024.Vanlinthout LE, Geniets B, Driessen JJ, Saldien V, Lapré R, Berghmans J, Uwimpuhwe G, Hens N. Neuromuscular-blocking agents for tracheal intubation in pediatric patients (0-12 years): A systematic review and meta-analysis. Paediatr Anaesth. 2020 Apr;30(4):401-414. doi: 10.1111/pan.13806. Epub 2020 Mar 9. PMID: 31887248.Tarquinio KM, Howell JD, Montgomery V, Turner DA, Hsing DD, Parker MM, Brown CA 3rd, Walls RM, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children; Pediatric Acute Lung Injury and Sepsis Investigators Network. Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study. Pediatr Crit Care Med. 2015 Mar;16(3):210-8. doi: 10.1097/PCC.0000000000000319. PMID: 25581629.Conway JA, Kharayat P, Sanders RC Jr, Nett S, Weiss SL, Edwards LR, Breuer R, Kirby A, Krawiec C, Page-Goertz C, Polikoff L, Turner DA, Shults J, Giuliano JS Jr, Orioles A, Balkandier S, Emeriaud G, Rehder KJ, Kian Boon JL, Shenoi A, Vanderford P, Nuthall G, Lee A, Zeqo J, Parsons SJ, Furlong-Dillard J, Meyer K, Harwayne-Gidansky I, Jung P, Adu-Darko M, Bysani GK, McCarthy MA, Shlomovich M, Toedt-Pingel I, Branca A, Esperanza MC, Al-Subu AM, Pinto M, Tallent S, Shetty R, Thyagarajan S, Ikeyama T, Tarquinio KM, Skippen P, Kasagi M, Howell JD, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children (NEAR4KIDS) and for the Pediatric Acute Lung Injury and Sepsis Investigators...

On Sept 10, 2023, er released an episode titled, “CS Ut Closure: Decidua or No Decidua?”. We highlighted the importance of AVOIDING the decidua at hysterotomy closure at CS. Now, in Sept 2025, in Obstetrics and Gynecology (the Green Journal), there is a new systematic review and meta-analysis on this very topic. Does this new study CONFIRM or REFUTE what we explained 2 years ago? Listen in for details. 1. Sept 10, 2023 Chapa Clinical Pearls Podcast: CS Ut Closure: Decidua or No Decidua?2. Lino GM, Galvão PVM, da Silva MLF, Conrado GAM. Not Closing Compared With Closing the Endometrial Layer During Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol. 2025 Jun 12;146(3):e55-e63. doi: 10.1097/AOG.0000000000005974. PMID: 40505112.

Herbs #22 and 23 on the top-selling herbs list for 2023 were milk thistle and black cohosh.Today we continue our series on commercially popular herbs, and share our views as herbalists on the actions, benefits, and applications of these.Milk thistle is widely known as an excellent herb for the liver, and this is a case where the common wisdom is correct. It's one of the safest herbs out there, and fortunately, it is also widely available and inexpensive. Hepatoprotective and even able to regenerate damaged liver tissue, it is at the same time a very gentle and benign plant. But don't try to make tea with it!Black cohosh's reputation is as a remedy for PMS and menopausal symptoms, and often this is attributed to phytoestrogenic activity or constituents. The reality is murky – and has remained so despite decades of argument and investigation on both sides of the claim. Regardless, black cohosh can often help. We find it best to view the herb through the lens of its action as a relaxant. If PMS or menopause are showing up with lots of tension, it's worth a try and most likely to help. But we can also apply that action much more broadly, for injuries, spasms, and (certain kinds of) headaches.22. Milk Thistle – Silybum marianaumMilk Thistle: Herb of the WeekMilk Thistle at Herbal RealityMilk Thistle in A Modern Herbal, M. Grieve, 1931 – presented in this text alongside multiple other thistles, which allows for close comparisons among them.23. Black Cohosh – Actaea racemosaWuttke, W., Seidlová-Wuttke, D. Black cohosh (Cimicifuga racemosa) is a non-estrogenic alternative to hormone replacement therapy. Clin Phytosci 1, 12 (2015). doi: 10.1186/s40816-015-0013-0.Mohapatra S, Iqubal A, Ansari MJ, Jan B, Zahiruddin S, Mirza MA, Ahmad S, Iqbal Z. Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review. Pharmaceuticals (Basel). 2022 Feb 23;15(3):278. doi: 10.3390/ph15030278. PMID: 35337076; PMCID: PMC8953734.Black Cohosh at Herbal RealityCimicifuga in King's American Dispensatory, 1898 – has an impressively long list of indications and applications for this remedy.If all you'd heard (before today) about black cohosh was that it's “good for menopause”, you might want to check out our Reproductive Health course! We discuss the whole range of human reproductive variability and herbal medicines to support all kinds of people. We even bust a few reproductive-health myths and herban legends. (Hint: vitex is not “a miracle herb for all women”!)If you have a moment, it would help us a lot if you could subscribe, rate, & review our podcast wherever you listen. This helps others find us more easily. Thank you!!Our theme music is “Wings” by Nicolai Heidlas.Support the showYou can find all of our online herbalism courses at online.commonwealthherbs.com!

If you're interested in boosting your cardiovascular fitness, I've got three steps for you to do.  Your cardiovascular fitness - VO2 max - is the most powerful predictor of longevity. Together with your lower body strength, they will tell the story of your future.    What is VO2 max? Oxygen consumed in milliliters per kilogram per minute. Strongest predictor of longevity, alongside lower body strength. VO2 Max and muscle mass peaks typically at age 25, with studies suggesting an average annual reduction of about 1% after.   Increasing your VO2 max can significantly increase your longevity. It can reduce all-cause mortality by 10-25%. Just going from low to above-average fitness levels can reduce mortality risk by 60-70% over a decade.    The 3 Steps to Improve Cardio Fitness 1. Long slow aerobic exercise  Walking, hiking, biking, swimming. Work just below threshold (can talk, slightly breathy). 80% of the time will be spent here. 20% should be spent doing HIIT or strength training. 2. High-Intensity Interval Training (HIIT)  10-15% improvement in 5-10 weeks 15–30 seconds of breathless effort (sprinting effect). Breathless in 30 seconds or less. 3. Strength training Improves muscle, may enhance your body composition or weight    Improving both your fitness (oxygen delivery and use) and reducing weight means your ml/kg/min will go up as you consume more oxygen with less body weight .. and even if you don't lose weight your muscle is metabolically active and consumes oxygen while fat doesn't.    So let's come back to the value of VO2 for reducing all cause mortality.  A modest increase of 3.5 ml/kg/min (1 MET) is all it takes to reduce all-cause mortality by up to 25%.    How do you know your Cardio Fitness is improving?    Short of getting a VO2 max test, you can measure in other ways:  Resting heart rate – first thing in morning  Recovery heart rate at end of interval and one minute later One-mile walk test   Why Muscle Still Matters? More muscle = higher oxygen demand → better VO2 Max. Fat mass doesn't contribute to oxygen use. Muscle quality declines with age → requires smarter training, especially during menopause.   Watch this episode on Flipping50TV YouTube.   References:  Journal of American College of Cardiology. 2018, PMID: 30384883. Circulation. 2007, PMID: 17548726.   Other Episodes You Might Like: Previous Episode - 80 Lb Perimenopausal Weight Loss After Corporate Burnout Next Episode - From Your Mouth to Your Gut: Hearing Health Whisper More Like This - Extended Cardio and Low Protein Equal Short Term Weight Loss   Resources:  Join the Hot, Not Bothered! Challenge to learn why timing matters and why what works for others is not working for you. Use Flipping 50 Scorecard & Guide to measure what matters with easy at-home self-assessment test you can do in minutes. Are you burning belly fat or burning out? Get the Menopause Fitness Guide to High-Intensity Interval Training to help you lose more fat and stay on track!  

Summer hikes and backyard play mean we're bound to see a few snakebites in the ED—and getting the first steps right makes all the difference. In the first half of this 2 part series, Medical Toxicologist Dr. Jonathan Ford joins us to walk through the key steps in caring for patients with snake envenomations. We'll walk through what to do (and not to do) in terms of pre-hospital care, how to triage and assess patients when they arrive in the ED, and how to decide which patients need antivenom. Dr. Ford reviews dosing strategies, monitoring, and key considerations for children, elderly, and pregnant patients. And we discuss practical guidance on supportive care, from pain control to wound management. By the end of this episode, you'll be ready to provide effective, evidence-based care for your next snakebite patient. Have you had a patient with a serious or challenging envenomation?  How did you manage it? Share your story with us social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Jonathan Ford, Professor of Emergency Medicine and Medical Toxicologist at UC Davis Resources: Seifert SA, Armitage JO, Sanchez EE. Snake Envenomation. N Engl J Med. 2022 Jan 6;386(1):68-78. doi: 10.1056/NEJMra2105228. PMID: 34986287; PMCID: PMC9854269. **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

According to the J Am Acad Orthop Surg Glob Res Rev. (2024), the incidence of pelvic ring injuries is 34.3 per 100,000 with trauma being the most obvious causation. Women account for approximately 69.7% of these injuries, 23% of which occur in women of childbearing age. In this specific patient population, concern is raised about one's future reproductive capability and method of delivery. The normal bony pelvic movements that occur during vaginal delivery are crucial for accommodating the passage of the fetus through the birth canal; this allows for the normal cardinal phases of labor to occur. These movements involve the widening and shifting of various pelvic joints and bones, primarily influenced by hormonal changes and the mechanical forces exerted by the baby. So, it is reasonable to ask if a patient with pelvic fractures and fixation can safely allow a trial of labor. Is a history of pelvic fractures with surgical fixation an indication for primary cesarean section? If it's not, in what scenario would a primary c-section be best after a pelvic fracture? Listen in for details. 1.Pelvic Fractures in Women of Childbearing Age.Cannada LK, Barr J. Clinical Orthopaedics and Related Research. 2010;468(7):1781-9. doi:10.1007/s11999-010-1289-5.2.Birth Outcomes Following Pelvic Ring Injury: A Retrospective Study. Hsu CC, Lai CY, Chueh HY, et al. BJOG : An International Journal of Obstetrics and Gynaecology. 2023;130(11):1395-1402. doi:10.1111/1471-0528.17487.3.Pregnancy and Delivery After Pelvic Fracture in Fertile-Aged Women: A Nationwide Population-Based Cohort Study in Finland. Vaajala M, Kuitunen I, Nyrhi L, et al. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2022;270:126-132. doi:10.1016/j.ejogrb.2022.01.008.4.Pregnancy Outcomes After Pelvic Ring Injury.Vallier HA, Cureton BA, Schubeck D. Journal of Orthopaedic Trauma. 2012;26(5):302-7. doi:10.1097/BOT.0b013e31822428c5.5.Caesarean Section Rates Following Pelvic Fracture: A Systematic Review. Riehl JT. Injury. 2014;45(10):1516-21. doi:10.1016/j.injury.2014.03.018.6.Unstable Pelvic Fractures in Women: Implications on Obstetric Outcome. Davidson A, Giannoudis VP, Kotsarinis G, et al. International Orthopaedics. 2024;48(1):235-241. doi:10.1007/s00264-023-05979-4.7.Management of Pelvic Injuries in Pregnancy.Amorosa LF, Amorosa JH, Wellman DS, Lorich DG, Helfet DL. The Orthopedic Clinics of North America. 2013;44(3):301-15, viii. doi:10.1016/j.ocl.2013.03.0058.Effect of Trauma and Pelvic Fracture on Female Genitourinary, Sexual, and Reproductive Function.Copeland CE, Bosse MJ, McCarthy ML, et al. Journal of Orthopaedic Trauma. 1997 Feb-Mar;11(2):73-81. doi:10.1097/00005131-199702000-00001.9. The Rate of Elective Cesarean Section After Pelvic or Hip Fracture Remains High Even After the Long-Term Follow-Up: A Nationwide Register-Based Study in Finland. Vaajala M, Kuitunen I, Liukkonen R, et al.European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2022;277:77-83. doi:10.1016/j.ejogrb.2022.08.10. Bajerová M, Hruban L. Movements of the pelvic bones of expectant mothers during vaginal delivery. Ceska Gynekol. 2024;89(4):335-342. English. doi: 10.48095/cccg2024335. PMID: 39242210. 11. Lewis AJ, Barker EP, Griswold BG, Blair JA, Davis JM. Pelvic Ring Fracture Management and Subsequent Pregnancy: A Summary of Current Literature. J Am Acad Orthop Surg Glob Res Rev. 2024 Feb 6;8(2):e23.00203. doi: 10.5435/JAAOSGlobal-D-23-00203. PMID: 38323930; PMCID: PMC10849384.12. Childbirth after Pelvic Fractures: Debunking the Myths: https://ota.org/sites/files/legacy_abstracts/ota09/otapa/OTA090132.htm13. Davidson A, Giannoudis VP, Kotsarinis G, Santolini E, Tingerides C, Koneru A, Kanakaris NK, Giannoudis PV. Unstable pelvic fractures in women: implications on obstetric outcome. Int Orthop. 2024 Jan;48(1):235-241. doi: 10.1007/s00264-023-05979-4. Epub 2023 Sep 15. PMID: 37710070

Contributor: Alec Coston, MD Educational Pearls: Hepatic encephalopathy (HE) is defined as a disruption in brain function that results from impaired liver function or portosystemic shunting. Manifests as various neurologic and psychiatric symptoms such as confusion, inattention, and cognitive dysfunction Although ammonia levels have historically been recognized as important criteria for HE, the diagnosis is ultimately made clinically. An elevated ammonia level lacks sensitivity and specificity for HE Trends in ammonia levels do not correlate with disease improvement or resolution A 2020 study published in the American Journal of Gastroenterology evaluated 551 patients diagnosed with hepatic encephalopathy and treated with standard therapy Only 60% of patients had an elevated ammonia level, demonstrating the limitations of ammonia levels However, a normal ammonia level in a patient with concern for HE should raise suspicion for other pathology. In patients with cirrhosis presenting with neuropsychiatric symptoms, consider HE as the diagnosis after excluding other potential causes of altered mental status (i.e., Seizure, infection, intracranial hemorrhage) The primary treatment is lactulose Works by acidifying the gastrointestinal tract. Ammonia (NH₃) is converted into ammonium (NH₄⁺), which is poorly absorbed and subsequently eliminated from the body Also exerts a laxative effect, further enhancing elimination References: Haj M, Rockey DC. Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis. Am J Gastroenterol. 2020 May;115(5):723-728. doi: 10.14309/ajg.0000000000000343. PMID: 31658104. Lee F, Frederick RT. Hepatic Encephalopathy-A Guide to Laboratory Testing. Clin Liver Dis. 2024 May;28(2):225-236. doi: 10.1016/j.cld.2024.01.003. Epub 2024 Jan 30. PMID: 38548435. Vilstrup, Hendrik1; Amodio, Piero2; Bajaj, Jasmohan3,4; Cordoba, Juan1,5; Ferenci, Peter6; Mullen, Kevin D.7; Weissenborn, Karin8; Wong, Philip9. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver. Hepatology 60(2):p 715-735, August 2014. | DOI: 10.1002/hep.27210 Weissenborn K. Hepatic Encephalopathy: Definition, Clinical Grading and Diagnostic Principles. Drugs. 2019 Feb;79(Suppl 1):5-9. doi: 10.1007/s40265-018-1018-z. PMID: 30706420; PMCID: PMC6416238. Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4 Get your tickets to Tox Talks Event, Sept 11, 2025: https://emergencymedicalminute.org/events-2/ Donate: https://emergencymedicalminute.org/donate/  

Traditionally, we have learned that any imbalance in the estrogen: progesterone relationship can trigger irregular uterine bleeding. That makes sense, right? During anovulation, prolonged unopposed estrogen can result in HMB. In such a case, we give progesterone as both a therapeutic as well as diagnostic intervention. On the contrary, with progestin only contraception, we consider estrogen predominant products when progesterone breakthrough bleeding (BTB) occurs to restore endometrial stabilization. But a new RCT (AJOG) adds credence to adding MORE progesterone in cases of progesterone associated BTB. Listen in for details.1. Zigler RE, Madden T, Ashby C, Wan L, McNicholas C. Ulipristal Acetate for Unscheduled Bleeding in Etonogestrel Implant Users: A Randomized Controlled Trial. Obstet Gynecol. 2018 Oct;132(4):888-894. doi: 10.1097/AOG.0000000000002810. PMID: 30130351; PMCID: PMC6153077.2.ANDRADE MCR, et al. Norethisterone for Prolonged Uterine Bleeding Associated with Etonogestrel Implant (IMPLANET): A Randomized Controlled Trial, American Journal of Obstetrics and Gynecology (2025), doi: https://doi.org/10.1016/j.ajog.2025.08.029.

Zone 2 is the most popular training zone - but is it the only training zone you need? We delve into all five training zones and their unique benefits. You'll learn how to determine each zone by heart rate, rate of perceived exertion (RPE), and talk test, plus how to use them in training. *Laura misspoke around minute 23. The Cori cycle converts lactate into glucose, not glycogen, to then be shuttled back into the muscles to undergo anaerobic glycolysis. Thank you to our sponsors:✨ Upstep: Custom orthotics, molded from the comfort of your home. Use code RUNTOTHEFINISH at https://www.upstep.com/?ref=cajmuang for $20 off your purchase. ✨ Previnex: Previnex creates clinically effective, third-party tested supplements made with high-quality ingredients, including Muscle Health Plus (creatine). Use the code treadlightly for 15% off your first order at previnex.comIn this episode, you will learn:✅ Why you need to train at intensities beyond zone 2✅ How to calculate your training zones✅ Is it worth running in zone 1?✅ Is zone 3 really “the gray zone”?✅ The value of threshold/zone 4 workouts✅ The benefits of training in zone 5 (interval training)✅ Why heart rate monitoring is less reliable in zone 5✅ Can heart rate zones be used on race day?References:

If you've ever doubted your ability to make muscle mass and strength gains after menopause, this episode is for you. It's not too late to gain strength and lean muscle mass can be gained at any age—even after 85.   Based on a 2024 Study on Resistance Training in Older Adults by Int. Journal of Sports Nutrition & Exercise Metabolism, here's what happened and the results: Participants:  17 adults aged 65–75. 12 adults aged 85+. Program:  Duration: 12 weeks, 3x per week Structure: Warm-up  4 lower body sets 3 upper body exercises (2 sets each) Stretching Results: Quadriceps strength increased in all participants 65–75 group: 1–18%  85+ group: 6–21%  1RM leg extension increased in all participants 65–75 group: 38% ± 20%  85+ group: 46% ± 14%  Improvements were seen in lean mass, strength and functional activities like chair stands, gait speed, timed up-and-go.   Defining Muscle Mass and Strength Gains After Menopause Exercise intensity is based on decreasing repetitions to muscular fatigue.  Exercise volume is based on the number of sets.   Considerations for Exercise Volume in Women in Menopause Volume = sets x reps x weight or total weekly workload. Start small (1–2 sets, 2x per week if inactive). Build to 3x only once consistent. Balance recovery: not just alternating workout/rest days, but also factoring in life stress. Menopausal women may need 48–72 hours between resistance sessions, per muscle group.   For women post menopause; increasing the number of days per week to reach greater exercise volume can be problematic because of the need for balance with recovery days. We don't mean 1 day work, 1 day rest. It can mean 1 day of high intensity work and 2 or 3 days light or moderate exercise for another type for recovery.   Start Your Strength Gains After Menopause The beginning phases of exercise should last longer for a woman starting in her 60s or 70s. Muscle, ligaments and tendons collectively are not as resilient at 60 as they were at 20. Since most early improvements are due to neural adaptations and heavier weights don't accelerate that, progress at a pace so you know you've exercised muscles but aren't sore or uncomfortable. You're in this for life. There's time.   The adaptive response to resistance training is preserved even in males and females over 85.   Protein & Resistance Training Two drivers of muscle protein synthesis: Resistance Training Adequate Protein. For metabolic health: ~100g/day (for 160 lb woman). For optimal fitness: closer to 160g/day. Protein recommendation for a 160lb adult is 60 grams of protein day. Only 46% of older adults get that.   5-Step Protein & Resistance Training Process: Track your current protein intake. Compare with recommendations based on age, weight, activity. Identify gaps without judgment. Close the gap gradually. Set short-term goals, especially starting with breakfast protein.   Muscle Mass and Strength Gains After Menopause are Dependent On… Relative Strength Training Power decreased significantly after the age of 50 years and was negatively and strongly associated with mobility limitations.   Mobility & Longevity Connection Strength must be paired with mobility to prevent limitations. Key focus areas: ankles, hips, upper back. Loss of mobility = harder to regain later. More… much more on mobility in upcoming posts. References:  Journal of Cachexia Sarcopenia and Muscle. 2021, PMID: 34216098. Journal of Nutrition, Health and Aging. 2019, PMID: 30932132. International Journal of Sport Nutrition and Exercise Metabolism. 2023, PMID: 37875254.   Other Episodes You Might Like: Previous Episode - Aging with Power, (Without an Outage) with Vonda Wright Next Episode - 80 Lb Perimenopausal Weight Loss After Corporate Burnout More Like This: What Is Sarcopenia and How to Avoid Sarcopenia In Menopause What's Best Total Body or Split Routine in Menopause   Resources for Strength Gains After Menopause:  Join the Hot, Not Bothered! Challenge to learn why timing matters and why what works for others is not working for you. Get the Flipping 50 STRONGER 12-week program for your at-home safe, sane, simple exercises. Get your lean, clean Flipping 50 Protein Powders to maintain muscle and support metabolism.  

LISTENER DISCRETION IS ADVISED. References: Buxton. Sustained Monomorphic VT: Clinical Manifestations, Diagnosis, and Evaluation. Up-to-Date. Farré J, Rubio JM, Sternick EB. Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room. Indian Pacing Electrophysiol J. 2023;23(1):1-13. doi:10.1016/j.ipej.2022.11.002 Kashou AH, Evenson CM, Noseworthy PA, et al. Differentiating wide complex tachycardias: A historical perspective. Indian Heart J. 2021;73(1):7-13. doi:10.1016/j.ihj.2020.09.006 Salim Rezaie, "SVT With Aberrancy Versus VT", REBEL EM blog, November 22, 2013. Available at: https://rebelem.com/svt-aberrancy-versus-vt/. 
Steinman RT, Herrera C, Schuger CD, Lehmann MH. Wide QRS tachycardia in the conscious adult. Ventricular tachycardia is the most frequent cause. JAMA. 1989 Feb 17;261(7):1013-6. PMID: 2915409. Vereckei A. Current algorithms for the diagnosis of wide QRS complex tachycardias. Curr Cardiol Rev. 2014 Aug;10(3):262-76. doi: 10.2174/1573403x10666140514103309. PMID: 24827795; PMCID: PMC4040878.

Breast cancer is an hormone responsive malignancy, meaning it may use estrogen and progesterone, reduced in high quantities during a pregnancy, for growth. However, as medical evidence evolves quickly, physicians have come to understand that breast cancer diagnosis during pregnancy doesn't always mean worse prognoses. While older studies- including meta analysis-reflected worse prognoses for pregnancy related breast cancer compared to non-pregnancy related cases, these studies either included studies from the 1960s and 70s when diagnosis and treatment were radically different, had inconsistent definitions of PABC, and/or were poorly age and staged matched. Therefore, as stated in the new UK (Aug 2025) guidance, “the applicability to modern day practice of the findings from these reports is limited”. The more updated clinical stance is that, “By using diagnostic and treatment pathways for women with {pregnancy related breast cancer} which are as close as possible to women with non-pregnancy related breast cancer, similar outcomes can be achieved” (RCOG Green Top recommendations No 12). In this episode, we will summarize key points from the recently released Green Top Guidance No 12 (25 Aug 2025) which has shifted the perspective on treating breast cancer DURING pregnancy. 1. Cubillo A, Morales S, Goñi E, Matute F, Muñoz JL, Pérez-Díaz D, de Santiago J, Rodríguez-Lescure Á. Multidisciplinary consensus on cancer management during pregnancy. Clin Transl Oncol. 2021 Jun;23(6):1054-1066. doi: 10.1007/s12094-020-02491-8. Epub 2020 Nov 16. PMID: 33191439; PMCID: PMC8084770.2. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/pregnancy-and-breast-cancer-green-top-guideline-no-12/3. Sundermann AC, Cate JM, Campbell AK, Dotters-Katz SK, Myers ER, Federspiel JJ. Maternal morbidity and mortality among patients with cancer at time of delivery. Am J Obstet Gynecol. 2023 Sep;229(3):324.e1-324.e7. doi: 10.1016/j.ajog.2023.06.008. Epub 2023 Jun 7. PMID: 37295633; PMCID: PMC10593119.

Episode 107 of Trail Society kicks off with life updates from Keely and Hillary, before diving into listener-submitted news and research. They discuss a BBC story where undercover officers highlighted the prevalence of street harassment, with 94% of local women reporting experiences of catcalling. This transitions into a conversation around exercise during pregnancy, sparked by a listener question about heart rate guidelines. The hosts review current research showing that, for athletes already active, higher intensity exercise can be safe and even beneficial during pregnancy, lowering risks like gestational diabetes and improving newborn Apgar scores. They emphasize that heart rate is an imprecise measure, and individualized approaches are important. The main feature of the episode is an interview with Anne Flower, an ER physician and elite trail runner who recently won and set a new course record at the Leadville 100, her debut 100-mile race. Anne shares how she balances training at a world-class level with her demanding medical career, and how lessons from the ER and ultrarunning inform each other. She reflects on her road-to-trail transition, the highs and lows of Leadville, and her mindset of tackling hard things as practice for resilience. Anne also discusses her role as Chief Medical Officer for Mountains to Mountains, her future racing goals, and offers advice for women entering the sport. The episode closes with listener shoutouts, stories of recovery after long races, training adaptations for different terrains, and heartfelt community support, reinforcing the podcast's commitment to uplifting women in endurance sports.   SPONSORSHIP:  We are so excited to be partnering with rabbit as our primary apparel sponsor this year! Send us some DMS about your favorite apparel and what you would like to see built for the trail running space!  So snag some of the new Trail Society x rabbit line before it's gone! New Code through the end of August—> HOPPER10   Keep sliding into our DMs with your messages, they mean so much to us!  FOLLOW US on Instagram: @trail.society And go follow our NEW youtube channel @trailsociety_podcast   Pregnancy and Exercise Research Citations:  Dalhaug EM, Sanda B, Bø K, Brown WJ, Sundgot-Borgen J, Haakstad LAH. Exceeding the guidelines: A descriptive study of exercise, pregnancy, maternal and neonatal health outcomes in elite and recreational athletes. BMC Pregnancy Childbirth. 2025 Apr 23;25(1):475. doi: 10.1186/s12884-025-07572-6. PMID: 40269794; PMCID: PMC12020307. Worska A, Laudańska-Krzemińska I, Ciążyńska J, Jóźwiak B, Maciaszek J. New Public Health and Sport Medicine Institutions Guidelines of Physical Activity Intensity for Pregnancy-A Scoping Review. J Clin Med. 2024 Mar 18;13(6):1738. doi: 10.3390/jcm13061738. PMID: 38541963; PMCID: PMC10971148.  

Weighted vests can be useful, but let's be honest about the benefits.Topics discussed:(00:06) - Who's excited about a weighted vest? (00:48) - Why is Lindsay not jumping on getting a weighted vest? (02:46) - Does it help with bone density? (03:28) - Does it build more muscle and strength? (05:54) - Does it burn more body fat? (13:56) - The nuance of the studies being used to justify weighted vests (21:08) - I love food! (26:43) - I appreciate your words of encouragement Walking alone is not a strong enough stimulus for muscle or bone.Inactive postmenopausal women who walked with or without a vest for 18 months had no significant bone density changes (PMID: 22338922). Full breakdown belowEven wearing a vest for 8 hours/day (PMID: 40540267) or 10 hours/day (PMID: 30095153) showed minimal skeletal benefit.The muscle and bone gains you see in the research?They're mostly in untrained individuals doing loaded exercises like squats, lunges, and jumps with the vest (PMID: 10995045, 9467434, 17724395).In these cases, the vest is just a hands-free way to add weight — not magic. As people progress, they'll need more load than a vest alone can provide.And for fat loss?Calorie burn from vest-walking is only ~10–15% higher than without it. That's 30–50 kcal for an hour walk — about a single untracked bite of food.Long-term fat loss comes from managing intake, not chasing small increases in burn. Your diet is the real game changer.If you lift weights regularly, walk, and are mindful about food, a weighted vest probably isn't a “must-have” for you. it's most effective in the right context.Study Overview: Walking With vs. Without a Weighted Vest  PMID: 22338922Authors & Journal: Tantiwiboonchai N., Kritpet T., Yuktanandana P. in Journal of the Medical Association of Thailand, 2011 (EurekaMag).Participants: 48 working women aged 30–60, randomly split into two groups: one walking with a weighted vest, the other walking without, on a treadmill 3×/week for 12 weeks (EurekaMag).Protocol: Vest group started walking without it for the first 2 weeks, then began adding 2% of body weight weekly until reaching 8% by week 6 (EurekaMag).FindingsBone Markers: Both groups showed large decreases in bone resorption (β-CrossLaps)—~19.1% for the vest group vs. ~21.8% for the non-vest group—no significant difference between them (EurekaMag).Physical Fitness: Improvements in leg and arm strength, endurance, and VO₂ max were seen in both groups—again, no significant differences between vest vs. non-vest walkers (EurekaMag).Bottom Line—What This MeansWalking, with or without a weighted vest, helped with fitness and reduced bone resorption—but wearing the vest didn't offer any extra benefit. So if you're thinking the vest is a cheat code for stronger bones or muscles… this study says otherwise.

Primary hyperparathyroidism is an underdiagnosed condition which leads to decreased bone mineral density, fracture, renal disease, among other symptoms that can decrease the quality of a patient's life. Moreover, once diagnosed, only a small fraction of patients with the diease end up being offered surgery. Whether it is because of misunderstood indications and benefits of surgery, non-localization of disease, or various other reasons, we thought it was worthwhile to review relevant literature. Hosts: Dr. Becky Sippel is an endowed professor of surgery at Division Chief of endocrine surgery at University of Wisconsin Madison and she is the most recent past president of the AAES.  She is an internationally recognized leader in the field of endocrine surgery. She has over 250 publications. She was the PI for a RCT which studies prophylactic central neck dissections which is a widely read and quoted study in endocrine surgery. Dr. Amanda Doubleday is a fellowship trained endocrine surgeon in private practice with an affiliation to UW Health. Her primary practice is with Waukesha Surgical Specialists in Waukesha WI.  Dr. Simon Holoubek is a fellowship trained endocrine surgeons affiliated with UW Health. He works for UW Health with privileges at UW Madison and UW Northern Illinois. His clinical interests are aggressive variants of thyroid cancer, parathyroid autofluorescence, and nerve monitoring.  Learning Objectives: 1 Understand the natural history of primary hyperparathyroidism and how the disease process can affect bone mineral density. 2 Learn about fracture risk associated with primary hyperparathyroidism. 3 Learn about decreased fracture risk in patients with primary hyperparathyroidism who have parathyroidectomy compared to those who are observed.  References: 1 Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, Udesky J, Silverberg SJ. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008 Sep;93(9):3462-70. doi: 10.1210/jc.2007-1215. Epub 2008 Jun 10. PMID: 18544625; PMCID: PMC2567863. https://pubmed.ncbi.nlm.nih.gov/18544625/ 2 Frey S, Gérard M, Guillot P, Wargny M, Bach-Ngohou K, Bigot-Corbel E, Renaud Moreau N, Caillard C, Mirallié E, Cariou B, Blanchard C. Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia. J Clin Endocrinol Metab. 2024 May 17;109(6):1494-1504. doi: 10.1210/clinem/dgad718. PMID: 38152848. https://pubmed.ncbi.nlm.nih.gov/38152848/ 3 VanderWalde LH, Liu IL, Haigh PI. Effect of bone mineral density and parathyroidectomy on fracture risk in primary hyperparathyroidism. World J Surg. 2009 Mar;33(3):406-11. doi: 10.1007/s00268-008-9720-8. PMID: 18763015. https://pubmed.ncbi.nlm.nih.gov/18763015/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen