Podcasts about s0140

Coronary artery calcification and exercise, translating clinical trials, the question of metabolically healthy obesity, and Watchman complications are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - CAC and Physical Activity - Physical Activity Paradoxically Tied to Higher Coronary Calcium https://www.medscape.com/viewarticle/959366 - Physical activity and the progression of coronary artery calcification http://dx.doi.org/10.1136/heartjnl-2021-319346 II - Translating Clinical Trials - SYNTAX Score II 2020 Wobbles in Real-World Validation https://www.medscape.com/viewarticle/958834 - Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation https://doi.org/10.1016/S0140-6736(20)32114-0 - External Validation of the SYNTAX Score II 2020 https://www.jacc.org/doi/full/10.1016/j.jacc.2021.07.027 III - Healthy and Obesity - ‘Metabolically Healthy Obesity' Has Heart Risks. Is it a Misnomer? https://www.medscape.com/viewarticle/959994 - Metabolically healthy obesity and cardiovascular events: A nationwide cohort study https://doi.org/10.1111/dom.14492 - Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults https://pubmed.ncbi.nlm.nih.gov/29501206/ - Paediatric obesity appears to lower the risk of diabetes if selection bias is ignored https://pubmed.ncbi.nlm.nih.gov/29374028 IV - Watchman Complications - FDA Investigating Potential Sex Differences in LAAO Adverse Outcomes https://www.medscape.com/viewarticle/959806 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Cardiac arrest care, finerenone, carotids, meds post TAVI: less is more and the new may not be as grand as the tried and true. John Mandrola, MD, provides a third ESC review. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - Cardiac Arrest Care - Angiography Can Wait for Cardiac Arrest Without ST-Elevation https://www.medscape.com/viewarticle/957471 - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa2101909 - Coronary Angiography after Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/full/10.1056/NEJMoa1816897 II - Finerenone - FIDELITY: Finerenone Cuts CV Risk in T2D Across CKD Spectrum https://www.medscape.com/viewarticle/957470 - Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2110956 - Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 III - Carotid Intervention - ACST-2: Carotid Stenting, Surgery on Par in Asymptomatic Patients https://www.medscape.com/viewarticle/957474 - Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy https://doi.org/10.1016/S0140-6736(21)01910-3 IV - Post TAVI DOAC - 'Less Is More' for Edoxaban in Post-TAVI Anticoagulation: ENVISAGE-TAVI AF https://www.medscape.com/viewarticle/957466 - Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR https://www.nejm.org/doi/full/10.1056/NEJMoa2111016 - ATLANTIS Hints at How to Choose Post-TAVR Antithrombotics https://www.medscape.com/viewarticle/951234 - A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement https://www.nejm.org/doi/full/10.1056/NEJMoa1911425 Features: - What Are the Implications of ACST-2 for Patients With Asymptomatic Carotid Stenosis? https://www.medscape.com/viewarticle/957502 - Top 5 Studies From ESC 2021 https://www.medscape.com/viewarticle/958598 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

ESC Wrap-up Part II: EMPEROR-Preserved, and the STEP, Guide-HF, and IAMI trials, are discussed by John Mandrola, MD, in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - HFpEF - EMPEROR-Preserved: Empagliflozin Scores HFpEF Breakthrough https://www.medscape.com/viewarticle/957405 - Empagliflozin in Heart Failure with a Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2107038 II - BP Targets - STEP: Lowering Blood Pressure Below 130 mm Hg Shows CV Benefit https://www.medscape.com/viewarticle/957566 - Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2111437 III- PA Catheter Monitoring - GUIDE-HF: CardioMEMS-Guided Meds Fall Short in Mild to Moderate Heart Failure https://www.medscape.com/viewarticle/957390 - Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial https://doi.org/10.1016/S0140-6736(21)01754-2 - Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial https://doi.org/10.1016/S0140-6736(11)60101-3 IV - Influenza Vaccine - Seasonal Flu Vax Cuts Post-MI Mortality in IAMI Trial https://www.medscape.com/viewarticle/957575 - Influenza Vaccination after Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial https://doi.org/10.1161/CIRCULATIONAHA.121.057042 - Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis https://pubmed.ncbi.nlm.nih.gov/20332404/ You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine. https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Bom dia, boa tarde, boa noite! Esse é mais um podcast do Medicina do Conhecimento. Ciência e informação a qualquer momento, em todo lugar. Eu sou Pablo Gusman, o Anestesiador. E como compartilhar é multiplicar lançamos uma série de podcasts para discutirmos e destacarmos a importância da prevenção da hipotermia perioperatória não intencional. Ninguém quer congelar seu paciente no intra-operatório, mas de forma frequente, nós os levamos a riscos de hipotermia não intencional. A hipotermia perioperatória inadvertida ou não intencional é considerada uma complicação frequente da cirurgia e pode ser evitada, desde que tomemos medidas preventivas. E trata-se de um evento que pode atingir até 90% dos pacientes cirúrgicos e é definida como a temperatura corporal central menor que 36.0°C. As repercussões são amplas e podem incluir alterações na farmacocinética de drogas hipnóticas, redução do fluxo sanguíneo hepático e aumento da duração de relaxantes musculares, publicado por trabalhos desde 1995 pelo grupo de Leslie e Sessler. DOI: 10.5482/HAMO-12-05-0011 A hipotermia perioperatória causa vasoconstrição periférica, diminuindo o oxigênio tecidual e tornando a ferida operatória mais suscetível à infecção, principalmente em cirurgias colorretais, mesmo que os níveis de contaminação sejam baixos. Melling publicou no Lancet um estudo controlado randomizado que conseguiu associar o aquecimento pré-operatório aos efeitos do uso de antibioticoprofilaxia em cirurgias limpas, sugerindo a redução de alergias e resistência ao uso dos antibióticos. Isso está cada vez mais atual frente aos protocolos de otimização e recuperação do paciente cirúrgico defendido e validado por várias sociedades de especialidade pelo mundo. DOI: 10.1016/S0140-6736(01)06071-8 Estudos internacionais mostram que a manutenção da temperatura corporal oferece vantagens significativas para a saúde do paciente, como redução de sangramento e diminuição da necessidade de produtos sanguíneos. O paciente sangra no intra-operatório e você não identifica causa aparente? Verifique e corrija acidose, hipotermia e o cálcio de seu paciente. Por isso escolha bem seu líquido de manutenção intraoperatória, sempre use métodos para manter a temperatura do paciente e inclua o cálcio como importante eletrólito para monitorização laboratorial durante sua anestesia. Junto com boa hemostasia cirúrgica, esse fatores corrigidos podem ser o fator diferencial para cessar a hemorragia intraoperatória. Você pode ouvir mais sobre esse tópico no podcast Sangramento no intraoperatório! Em artigo do Departamento de Anastesia e Cuidados Intensivos do Hospital de Amstetten, Austria, Schmied e Reiter evidenciaram que a hipotermia central em pacientes submetidos a artroplastia de quadril pode aumentar em até 500 ml o volume de perdas sanguíneas. Em pacientes idosos e muitas vezes com anemia pré-operatória, a perda desse volume pode ser decisivo para eventos adversos no perioperatório. DOI: 10.1016/S0140-6736(96)90466-3 Do ponto de vista da proteção cardiovascular, a manutenção da normotermia perioperatória reduz a morbidade dos eventos cardíacos. Em ensaio clínico randomizado publicado no JAMA, 300 pacientes submetidos a procedimentos abdominais, vasculares e torácicos com história ou risco aumentado para doença coronária apresentaram diminuição de eventos cardiovasculares. Em analise multivariável, a hipotermia foi um preditor independente de eventos cardíacos, indicando 55% de redução do risco na manutenção da normotermia. Além disso, taquicardia ventricular ocorreu em menor incidência no grupo de normotermia. Lembre-se que sempre vale a pena manter seu coração aquecido! DOI: 10.1001/jama.1997.03540380041029 “Esse podcast tem o apoio científico da 3M Health Care. A 3M acredita no poder da ciência para criar soluções que impactam a vidas dos pacientes, profissionais e instituições de saúde, reduzindo complicações relacionadas à assistência à saúde, como a hipotermia perioperatória.”

Baricitinib is a Janus kinase 1/2 inhibitor the has been shown to decrease mortality in COVID-19 patients who are on HFNC or NIV. Show Notes: https://eddyjoemd.com/baricitinib-covid/ Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom. Website: www.eddyjoemd.com Instagram: www.instagram.com/eddyjoemd Twitter: www.twitter.com/eddyjoemd Facebook: www.facebook.com/eddyjoemd Podcast: https://anchor.fm/eddyjoemd My Amazon store for resources you may find helpful: www.amazon.com/shop/eddyjoemd Citation: RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021 May 1;397(10285):1637-1645. doi: 10.1016/S0140-6736(21)00676-0. PMID: 33933206; PMCID: PMC8084355. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/eddyjoemd/support

In the last episode of series 3, we're joined by Anne Peters, Professor of Clinical Medicine at the Keck School of Medicine of the University of Southern California, USA, to discuss recent data on potential new therapies in development, and what this might mean in the future. For more free education, visit the DKIP website, follow us on Twitter (@dkipractice) or connect on LinkedIn. References Rosenstock J, et al. Lancet. 2021 Jun 25;S0140-6736(21)01324-6 [SURPASS-1]. Frias J P, et al. N Engl J Med. 2021 Jun 25. doi: 10.1056/NEJMoa2107519. Online ahead of print [SURPASS-2] Abstract 78-LB: Efficacy and Safety of Tirzepatide, a Dual GIP/GLP-1 Receptor Agonist, Compared with Insulin Degludec in Patients with Type 2 Diabetes (SURPASS-3) Abstract 80-LB: Tirzepatide, a Dual GIP/GLP-1 Receptor Agonist, Is Effective and Safe When Added to Basal Insulin for Treatment of Type 2 Diabetes (SURPASS-5) Bhatt D L, et al. Late-Breaking Clinical Trials IV. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting). Disclosures: Prof. Anne Peters declares the following: Participation on an advisory board: Abbott Diabetes Care, Astra Zeneca, Eli Lilly, Medscape, Novo Nordisk, Zealand Research Support: Dexcom, Insulet and donated devices from Abbott Diabetes Care Stock Options: Omada Health, Teladoc All conflicts of interest have been mitigated prior to this activity. Funding statement: This independent educational activity is supported by educational grants from Eli Lilly, Merck Sharp and Dohme Corp. and Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; the financial supporters have had no influence on the content of this education.

Episode 61: Semaglutide for Obesity.  Dr Arreaza discusses with Dr Carranza the results of the STEP trials: Semaglutide Treatment Effect in People with obesity, which allowed semaglutide gain FDA approval as a treatment for obesity.By Hector Arreaza, MD, and Claudia Carranza, MDThis is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. One of the major challenges of modern medicine is to find an effective treatment for obesity.Obesity was considered a disease in 1998 by the National Institutes of Health[1].In 2002, the Internal Revenue Service, AKA the feared IRS, issued a statement to make obesity treatment a deductible medical expense. Who would have known that obesity was tax deductible?Later, in 2013 obesity was accepted as a complex, chronic disease by the American Medical Association[2]. Many other organizations have made statements in favor or against the definition of obesity as a disease.We recently announced the exciting news of semaglutide as a new FDA-approved medication for the chronic treatment of obesity. Today we want to give you a very brief summary (brief-ísimo) of the trials that allowed semaglutide to gain that FDA-approval. Semaglutide was tested at different levels with the STEP trials. STEP stands for Semaglutide Treatment Effect in People with obesity (STEP). All these trials were done in 68 weeks, all patients received counseling about lifestyle modifications, 70-80% were women, ages averaging 40-50 years old.STEP 1: Does semaglutide cause weight loss in patients without diabetes?The focal point of this trial was weight management with semaglutide in patients without diabetes. This was a double-blind trial. There were 1961 participants enrolled. A group was assigned to placebo and another group was assigned to weekly injection of semaglutide. For the semaglutide group, the goal dose of semaglutide was 2.4 mg, starting with 0.25 mg, increasing every 4 weeks: 0.5 -> 1.0 -> 1.7 -> 2.4 (reaching the goal dose in 4 months), 3 out of 4 participants were Caucasians. Outcomes: after 68 weeks weight reduction was -16.9% in patients on semaglutide, more than 86% of participants had a weight loss >5%, 69% lost >10% of their weight, and 50% percent lost >15% of their body weight, and about 32% lost >20% of their weight. This may be comparable to bariatric surgery in some patients; however, the weight loss is not as dramatic. Other parameters improved were waist circumference, blood pressure, triglycerides. LDL and total cholesterol were not significantly affected. There was a clinical meaningful change in 40% of patients. 7 out of 100 could not complete trial for GI adverse effects, most commonly nausea, diarrhea, vomiting, constipation. Acute pancreatitis presented in 0.2% of the semaglutide group (all recovered during study) vs 0% in the placebo group[3]. STEP 2: Does semaglutide cause weight loss in patients with diabetes? The focal point of this study was weight management with semaglutide in type 2 diabetes mellitus. 1210 patients participated in 12 different countries across Europe, North America, South America, the Middle East, South Africa, and Asia. Patients were randomly assigned to semaglutide 2.4 mg weekly, Semaglutide 1 mg weekly, or placebo. Weight loss was superior with semaglutide 2.4 mg, -9.6% of body weight with semaglutide vs -3.4% weight loss with placebo. As you can see, weight loss in individuals with diabetes is more difficult. The effect on diabetes control was about the same with semaglutide 1 mg vs 2.4 mg. The 1 mg dose reduced A1C -1.5%, and the reduction was -1.6% with semaglutide 2.4 mg. A1C reduction was about the same regardless of weight loss. STEP 3: Does Intensive Behavioral Therapy increases weight loss in patients using semaglutide?Intensive behavioral therapy was put to the test. 611 participants were enrolled. Each patient in this study received IBT: 30 brief sessions, 19 in the first 24 weeks, monthly thereafter provided by a registered dietitian. Participants had obesity and overweight, lived in 41 states in the US, had >1 related comorbidity, no diabetes. They all were put on a low-calorie diet for 8 weeks and were randomized to receive either semaglutide or placebo. Weight loss was accelerated by the low-calorie diet and IBT earlier in the study, but at the end there was only 1% difference between the two groups, 17.6% weight loss with IBT vs 16.9% weight loss without IBT. Further research is needed to determine the potential benefits of including a low-carb diet to semaglutide to increase long term weight loss. STEP 4: What happens to weight loss if we stop semaglutide?The focal point of this study was sustained weight management. Patients were randomized to placebo or semaglutide after 20 weeks, but continued lifestyle modificationsThose who remained in semaglutide, continued to lose weight up to 18% (lost 8% additional weight). The placebo arm gained half of their weight back. If you stop the medication weight is likely to come back. Weight loss comparison: Contrave® (bupropion-naltrexone) and Saxenda (liraglutide) ~5% weight loss, Qysimia® (phentermine-topiromate ~9%), semaglutide (Wegovy®) is about 15%. The average weight loss with semaglutide is higher than other meds, including liraglutide, after 1 year of use. Medullary thyroid cancer: Not shown to be increased risk.Newer medications that act on the GLP-1 receptors are showing increased rates of weight loss.• IBT is less important in weight management if a highly effective medication is used to curb appetite•Improved glucose control and CVD risk reduction is achieved when patients have ≥10% weight reduction•Obesity is a complex chronic disease that requires long-term managementCredit: This summary was inspired by Dr Robert F. Kushner, Professor of Medicine, Northwestern University Feinber School of Medicine. Conclusion: Now we conclude our episode number 62 “Semaglutide for Obesity”. After listening to this episode, we hope you understand the role of semaglutide in the treatment of obesity. Semaglutide has shown to cause weight loss in patient with and without diabetes, and the benefits go beyond weight reduction to include lower blood pressure and triglycerides, among other health markers. Semaglutide is not for everyone, but it can surely be the answer to many of your patients with obesity. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza and Claudia Carranza. Audio edition: Suraj Amrutia. See you next week! _____________________References:Kyle TK, Dhurandhar EJ, Allison DB. Regarding Obesity as a Disease: Evolving Policies and Their Implications. Endocrinol Metab Clin North Am. 2016;45(3):511-520. doi:10.1016/j.ecl.2016.04.004, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988332/ AMA House of Delegates Adopts Policy to Recognize Obesity as a Disease, Obesity Medicine Association, June 19, 2013, https://obesitymedicine.org/ama-adopts-policy-recognize-obesity-disease/ Wildings, John P.H. et al., Once-Weekly Semaglutide in Adults with Overweight or Obesity, N Engl J Med 2021; 384:989-1002, DOI: 10.1056/NEJMoa2032183. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 (STEP1) Davies, Melanie et. al, Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial, The Lancet, March 02, 2021, DOI: https://doi.org/10.1016/S0140-6736(21)00213-0   (STEP 2) Wadden TA, Bailey TS, Billings LK, Davies M, et. al. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial. JAMA. 2021 Apr 13;325(14):1403-1413. doi: 10.1001/jama.2021.1831. PMID: 33625476; PMCID: PMC7905697. https://jamanetwork.com/journals/jama/article-abstract/2777025 (STEP 3) Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414–1425. doi:10.1001/jama.2021.3224. https://jamanetwork.com/journals/jama/article-abstract/2777886 (STEP 4) 

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the second of two episodes covering the topic of eating disorders. In this episode, we explore the treatment of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital.    The learning objectives for the episode are as follows:   By the end of this episode, you should be able to… Outline the management of eating disorders using a biopsychosocial framework. Identify the indications for various levels of care (inpatient, residential, day hospital, outpatient, etc). Understand the ethical and medicolegal dilemmas (i.e. involuntary treatment) that may arise in treatment of eating disorders. Consider the treatment of special populations (i.e. children and adolescents, older adults, men, LGBTQ+ individuals).   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY3), Dr. Vanessa Aversa (PGY4)   Audio editing by: Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa, Dr. Nikhita Singhal   Interview Content: Introduction - 0:00  Learning objectives - 00:39 Biological approaches to treatment: Nutritional rehabilitation - 03:47 Medications - 06:00 Psychological approaches to treatment -16:35 Treatment of comorbidities - 23:45 Levels of care - 26:00 Ethical dilemmas - 32:40 Special populations: Children and adolescents - 35:35 Older adults - 36:45 Men - 37:55 LGBTQ+ - 40:23 Novel interventions - 42:48 Closing - 51:47   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca. The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca. Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10 Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019. Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders. 3rd ed. 2006. Geller J, Isserlin L, Seale E, et al. The short treatment allocation tool for eating disorders: current practices in assigning patients to level of care. J Eat Disord. 2018;6(45). https://doi.org/10.1186/s40337-018-0230-2 McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008 Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232 Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7 Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.   For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Today we sit down (in person!) with Dr. Jeff Bien of Stanford University to break down all the details -- from the methods to the statistical analysis to the conclusions -- of the CheckMate 649 trial, which pitted first-line nivolumab plus chemotherapy against chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma. CheckMate 649: doi.org/10.1016/S0140-6736(21)00797-2 Back us on Patreon! www.patreon.com/plenarysession Check out our YouTube channel: www.youtube.com/channel/UCUibd0E2kdF9N9e-EmIbUew

Contributor: Ricky Dhaliwal, MD Educational Pearls: CRASH 3 Trial looked at over 12,000 patients with traumatic intracranial bleeds, randomizing patients to a therapy with TXA or standard of care without TXA Dosing was 1 gram over 10 min for loading dose and then an infusion of 1 gram over 8 hours Found Improvement in survival and neurologic outcomes when patient received TXA within 3 hours References CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial [published correction appears in Lancet. 2019 Nov 9;394(10210):1712]. Lancet. 2019;394(10210):1713-1723. doi:10.1016/S0140-6736(19)32233-0   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

This year's Scientific Sessions of the American Diabetes Association was the second in a row to be held virtually. Nevertheless, the conference was still packed with the usual informative symposia and original research we would expect from ADA. We spoke to three of the speakers to discuss the highlights, including: - Professor Anne Peters on STEP, SUSTAIN FORTE and AMPLITUDE-O - Dr Deborah Wexler on GRADE - Professor Francesco Giorgino on the SURPASS programme For more free education, visit the DKIP website, follow us on Twitter (@dkipractice) or connect on LinkedIn. References - The Management of Type 1 Diabetes in Adults — A Consensus Report by the ADA and EASD (draft) - Abstract 101-OR: Efficacy and Safety of Once-Weekly Semaglutide 2.0 vs. 1.0 mg for Type 2 Diabetes: SUSTAIN FORTE Randomized Trial - Wilding J, et al. N Engl J Med. 2021 Mar 18;384(11):989 [STEP 1]. - UK Prospective Diabetes Study - Nathan D, et al. Diabetes Care 2013 Aug; 36(8): 2254-2261 [GRADE]. - Rosenstock J, et al. Lancet. 2021 Jun 25;S0140-6736(21)01324-6 [SURPASS-1]. - Frias J P, et al. N Engl J Med. 2021 Jun 25. doi: 10.1056/NEJMoa2107519. Online ahead of print [SURPASS-2] - Abstract 78-LB: Efficacy and Safety of Tirzepatide, a Dual GIP/GLP-1 Receptor Agonist, Compared with Insulin Degludec in Patients with Type 2 Diabetes (SURPASS-3) - Abstract 80-LB: Tirzepatide, a Dual GIP/GLP-1 Receptor Agonist, Is Effective and Safe When Added to Basal Insulin for Treatment of Type 2 Diabetes (SURPASS-5) Disclosures: Prof. Anne Peters declares the following: Participation on an advisory board: Abbott Diabetes Care, Astra Zeneca, Eli Lilly, Medscape, Novo Nordisk, Zealand Research Support: Dexcom, Insulet and donated devices from Abbott Diabetes Care Stock Options: Omada Health, Teladoc Dr Deborah Wexler declares the following: Member of data monitoring committee for SOUL and FLOW trials studying semaglutide, a GLP_1 receptor agonist: Novo Nordisk Prof. Francesco Giorgino declares the following: Grants/Research Support recipient: Eli Lilly, Roche Diabetes Care Consultant (Occasional): Eli Lilly, Roche Diabetes Care, Boehringer Ingelheim, NovoNordisk, Sanofi Honorarium recipient: Eli Lilly, Roche Diabetes Care, Boehringer Ingelheim, NovoNordisk, AstraZeneca, Sanofi, Mundipharma Funding statement: This independent educational activity is supported by educational grants from Eli Lilly, Merck Sharp and Dohme Corp. and Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; the financial supporters have had no influence on the content of this education.

COVID-19, mRNA-vaccine-induced myocarditis, type 2 diabetes in kids, optimal medical therapy for CAD, and Alcohol are the topics discussed by John Mandrola, MD, in this week's podcast. https://www.medscape.com/twic 1-COVID - Fast-spreading Delta Variant, Vaccination Rates, Reintroduction of Indoor Masks: COVID-19 Global Weekly Highlights https://www.medscape.com/viewarticle/940446 - Health care 'breaking point': Cox confirms some Springfield COVID-19 patients transferred to St. Louis, Kansas City https://www.news-leader.com/story/news/local/ozarks/2021/06/29/springfield-covid-delta-variant-missouri-hospitals-cox-some-patients-transferred-vaccines/7787970002/ 2- COVID Vaccine-Induced Myocarditis - New Details of Myocarditis Linked to COVID Vaccines https://www.medscape.com/viewarticle/954061 - Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military https://jamanetwork.com/journals/jamacardiology/fullarticle/2781601 - Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination https://jamanetwork.com/journals/jamacardiology/fullarticle/2781602 3- Diabetes in the Clinic - 'Staggering' Doubling of Type 2 Diabetes in Kids During Pandemic https://www.medscape.com/viewarticle/953816 4- Optimal Medical Therapy - OMT 'Best Insurance' for Extended Survival After Revascularization https://www.medscape.com/viewarticle/953959 - Impact of Optimal Medical Therapy on 10-Year Mortality After Coronary Revascularization https://doi.org/10.1016/j.jacc.2021.04.087 - Defining the Proper SYNTAX for Long-Term Benefit of Myocardial Revascularization With Optimal Medical Therapy https://doi.org/10.1016/j.jacc.2021.04.088 - Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. https://www.nejm.org/doi/full/10.1056/nejmoa0804626 - Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial https://doi.org/10.1016/S0140-6736(19)31997-X 5- Alcohol - The Sick-Quitter Effect: How Alcohol Can Seem Cardioprotective When It Isn't https://www.medscape.com/viewarticle/953696 Features: - Vaccine-Induced Myocarditis Concerns Demand Respect, Not Absolutism https://www.medscape.com/viewarticle/954038 You may also like: - Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine - The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Neste episódio, contamos com a participação do Dr. Bruno Muzzi para conversar sobre Romosozumabe. Dr. Bruno Muzzi é ginecologista com doutorado em saúde da mulher pela UFMG, coordenador do serviço de densitometria óssea do Mater Dei e conselheiro científico da Internacional Osteoporosis Foundation. Referências: 1) FRAME: Cosman F, Crittenden DB, Adachi JD, et al. Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med 2016;375:1532-43 2) ARCH: Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. September 11, 2017. DOI: 10.1056/NEJMoa1708322 3) STRUCTURE: Langdahl BL, Libanati C, Crittenden DB, Bolognese MA, Brown JP, Daizadeh NS, Dokoupilova E, Engelke K, Finkelstein JS, Genant HK, Goemaere S, Hyldstrup L, Jodar-Gimeno E, Keaveny TM, Kendler D, Lakatos P, Maddox J, Malouf J, Massari FE, Molina JF, Ulla MR, Grauer A. Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy: a randomised, open-label, phase 3 trial. Lancet. 2017 Sep 30;390(10102):1585-1594. doi: 10.1016/S0140-6736(17)31613-6. Epub 2017 Jul 26. PMID: 28755782. 4) BRIDGE: Lewiecki EM, Blicharski T, Goemaere S, Lippuner K, Meisner PD, Miller PD, Miyauchi A, Maddox J, Chen L, Horlait S. A Phase III Randomized Placebo-Controlled Trial to Evaluate Efficacy and Safety of Romosozumab in Men With Osteoporosis. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3183-3193. doi: 10.1210/jc.2017-02163. PMID: 29931216.

Neste episódio, contamos com a participação do Dr. Bruno Muzzi para conversar sobre Romosozumabe.  Dr. Bruno Muzzi é ginecologista com doutorado em saúde da mulher pela UFMG, coordenador do serviço de densitometria óssea do Mater Dei e conselheiro científico da Internacional Osteoporosis Foundation. No próximo episódio: avaliar falha terapêutica e o que fazer, quais são as contraindicações e riscos de fratura atípica e necrose de mandíbula do Romosozumabe.  Referências: 1) FRAME: Cosman F, Crittenden DB, Adachi JD,  et al. Romosozumab treatment in postmenopausal women with osteoporosis.  N Engl J Med 2016;375:1532-43 2) ARCH: Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. September 11, 2017. DOI: 10.1056/NEJMoa1708322 3) STRUCTURE: Langdahl BL, Libanati C, Crittenden DB, Bolognese MA, Brown JP, Daizadeh NS, Dokoupilova E, Engelke K, Finkelstein JS, Genant HK, Goemaere S, Hyldstrup L, Jodar-Gimeno E, Keaveny TM, Kendler D, Lakatos P, Maddox J, Malouf J, Massari FE, Molina JF, Ulla MR, Grauer A. Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy: a randomised, open-label, phase 3 trial. Lancet. 2017 Sep 30;390(10102):1585-1594. doi: 10.1016/S0140-6736(17)31613-6. Epub 2017 Jul 26. PMID: 28755782. 4) BRIDGE:  Lewiecki EM, Blicharski T, Goemaere S, Lippuner K, Meisner PD, Miller PD, Miyauchi A, Maddox J, Chen L, Horlait S. A Phase III Randomized Placebo-Controlled Trial to Evaluate Efficacy and Safety of Romosozumab in Men With Osteoporosis. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3183-3193. doi: 10.1210/jc.2017-02163. PMID: 29931216.

La Organización Mundial de la Salud recomienda considerar ECMO en pacientes adultos y pediátricos con COVID-19 y SDRA refractario, si hay un equipo de expertos disponible. Primera revisión. Un artículo disponible online el 4 de noviembre de 2020 en Elservier, “Consenso ECMO colombiano para paciente con falla respiratoria grave asocia da a COVID-19”. En pacientes con síndrome de dificultad respiratoria aguda grave refractaria con sospecha o confirmación de COVID-19. Tenemos 7 conclusiones así: 1. Si se debería considerarse la oxigenación con membrana extracorpórea vs. continuar con el manejo estándar para disminuir la mortalidad a 60 días. 2. El tratamiento óptimo que deben recibir antes de considerar el uso de ECMO, seria recibir ventilación pulmonar protectora de acuerdo con la estrategia ARDS-Net, sedación profunda y relajación muscular, ventilación prona además de prevención y manejo de la hipervolemia. Segunda revisión. 1. 176 pacientes (17%) fueron dados de alta a otro hospital. 2. 380 pacientes (37%) fallecieron. 3. La incidencia acumulada estimada de mortalidad intrahospitalaria 90 días después del inicio de la ECMO fue de 37,4%. 4. La mortalidad fue del 39% (380 de 968) en pacientes con disposición final de fallecimiento o alta hospitalaria. Tercera revisión. Total, casos de COVID-19 1. Sospechoso o confirmado de COVID-19 7384 pacientes 2. Casos confirmados de COVID-19 7357 pacientes Pacientes que iniciaron ECMO hace al menos 90 días 1. COVID-19 Confirmado 6116 pacientes 2. Mortalidad hospitalaria COVID-19 49%. REFERENCIA https://www.elsevier.es/es-revista-acta-colombiana-cuidado-intensivo-101-avance-resumen-consenso-ecmo-colombiano-paciente-con-S0122726220300811 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538114/pdf/main.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538114/ https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932008-0 https://www.elso.org/Registry/FullCOVID19RegistryDashboard.aspx https://apps.who.int/iris/bitstream/handle/10665/332196/WHO-2019-nCoV-clinical-2020.5-eng.pdf?sequence=1&isAllowed=y ADAPTACION PARA AUDIO-OYENTES: Medicina en una página. ================================================ PODCAST CORONAVIRUS. COVID-19 Este es un podcast en el que desde el ojo de la ciencia. Aprenderemos del coronavirus y de la enfermedad covid-19. Recuerden al enemigo es mejor conocerlo. Para acabarlo. Esta es una producción de: Medicina en una página. medicinaenunapagina@gmail.com Dirección y Conducción: John Jarbis García Tamayo. Médico y cirujano, Epidemiólogo y Pedagogo Universitario.

Contributor:  Aaron Lessen, MD Educational Pearls: Refractory ventricular fibrillation, defined as 3 defibrillation shocks without resolution, was studied via RCT looking to compare ECMO with cardiac cath vs. typical resuscitation After 30 patients (15 each arm), the trial was stopped because such a significant benefit seen in the ECMO arm 6 patients survived and 3 had good neurological outcomes at 6 months with ECMO This is compared to 1 patient surviving initially and none surviving at 6 months in the typical resuscitation arm References Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.  Donate to EMM today!

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This is the first of two episodes covering the topic of eating disorders. In this episode, we explore the diagnosis, etiology, and symptomatology of these illnesses with Dr. Randy Staab, a psychiatrist at Trillium Health Partners and medical director of the eating disorders program at Credit Valley Hospital. Dr. Staab joins us again for Part 2, which will focus on eating disorder treatment.   By the end of this episode, you should be able to… Recognize the clinical features of the following eating disorders using DSM-5 diagnostic criteria:  Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) Avoidant/Restrictive Food Intake Disorder (ARFID) Other Specified Feeding or Eating Disorder (OSFED) Identify predisposing factors for eating disorders using a biopsychosocial framework. List common comorbid psychiatric conditions associated with eating disorders. Identify and describe the medical complications of eating disorders.   Guest: Dr. Randolf “Randy” Staab   Hosts: Dr. Lucy Chen, Dr. Nikhita Singhal (PGY2), Dr. Vanessa Aversa (PGY3)   Audio editing by: Dr. Nikhita Singhal, Dr. Vanessa Aversa   Show notes by: Dr. Vanessa Aversa   Interview Content: Introduction - 0:00  Learning objectives - 2:08 DSM-5 definition, clinical features, and associated comorbidities of: Anorexia Nervosa (AN) - 4:27 Bulimia Nervosa (BN) - 12:36 Binge Eating Disorder (BED) - 18:08 Avoidant/Restrictive Food Intake Disorder (ARFID) - 21:43 Other Specified Feeding or Eating Disorder (OSFED) - 26:21 Approach to the initial assessment of a patient with an eating disorder - 29:45 Predisposing factors and explanatory models for the development of eating disorders: Biological factors - 38:10 Psychological factors - 44:00 Sociocultural factors - 48:02 Onset of eating disorders - 49:34 Possible precipitating factors - 51:50 Medical complications of eating disorders: Cardiovascular - 56:13 Endocrine - 58:09 Musculoskeletal - 1:03:20 Gastrointestinal - 1:05:17 Neurological - 1:08:13 Renal - 1:08:59 Dermatological - 1:09:26 Relevant laboratory investigations - 1:11:27 Overview of refeeding syndrome - 1:12:30 Closing - 1:14:27   Resources: The National Eating Disorder Information Centre (NEDIC) provides information, resources, referrals and support to Canadians affected by eating disorders: https://nedic.ca. The National initiative for Eating Disorders (NIED) provides access to educational, informational, and other recovery-oriented resources related to eating disorder prevention and treatment: https://nied.ca. Body Brave provides accessible eating disorder treatment and support, as well as community training and education: https://bodybrave.ca.   References: American Psychiatric Association. Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders. 5th ed. https://doi.org/10.1176/appi.books.9780890425596.dsm10 Gaudiani J. Sick Enough: A Guide to the Medical Complications of Eating Disorders. New York, NY: Routledge; 2019. Mehler PS, Andersen AE. Eating Disorders: A Guide to Medical Care and Complications. 3rd ed. Baltimore, MD: Johns Hopkins University Press; 2017. McClain Z, Peebles R. Body image and eating disorders among lesbian, gay, bisexual, and transgender youth. Pediatr Clin North Am. 2016 December; 63(6):1079–1090. https://doi.org/10.1016/j.pcl.2016.07.008 Mangweth-Matzek B, Hoek HW, Rupp CI, Lackner-Seifert K, Frey N, Whitworth AB, Pope HG, Kinzl J. Prevalence of eating disorders in middle-aged women. Int J Eat Disord. 2014 April; 47(3):320–324. https://doi.org/10.1002/eat.22232 Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583–593. https://doi.org/10.1016/S0140-6736(09)61748-7 Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013;26(6):543‐548. https://doi.org/10.1097/yco.0b013e328365a24f   CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Geronimo Bejarano is a former chiropractic student at Palmer College of Chiropractic - Florida, whose recent Twitter thread announcing his withdrawal from chiropractic school went viral.Geronimo is now a hopeful 2022 PhD applicant. He is a self-described research nerd, with interests in social determinants of health (SDoH), community based interventions, physical activity promotion and non-communicable diseases.Twitter: @gero5Instagram: @geronimo10LinkedIn: Geronimo BejaranoResearchGate: Geronimo BejaranoDiscussion Topics00:00:01 Teaser Intro00:02:24 When I grow up00:03:41 Introduction to chiropractic00:09:12 Early reading & influences00:13:31 Choosing chiropractic vs. PT00:16:33 Choosing a chiropractic school00:19:15 Early experience in school00:25:02 Philosophy in the curriculum00:27:48 Learning about research00:33:21 Disillusionment - Is “American Chiro doomed?”00:36:56 Comparing students’ experiences00:39:51 X-ray requirements00:43:51 Response to Twitter thread00:46:49 Fixing the problem from within00:49:08 Intention and misinterpretation00:59:45 Systemic issues vs. Personal fit01:02:02 How to read a paper01:05:20 Top 3 recommended MSK research papers01:05:33 Making time to read01:09:24 Not taking and synthesizing01:11:10 On writing01:13:25 Recommendations for students01:16:38 OutroRESOURCESTop 3 MSK Research PapersHartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q. A., Ferreira, M. L., Genevay, S., et al. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 1–12.Rethorn, Z. D., Cook, C., & Reneker, J. C. (2019). Social Determinants of Health: If You Aren“t Measuring Them, You Aren”t Seeing the Big Picture.The Journal of Orthopaedic and Sports Physical Therapy, 49(12), 872–874.Karran, E. L., Grant, A. R., & Moseley, G. L. (2020). Low back pain and the social determinants of health: a systematic review and narrative synthesis.Pain, 161(11), 2476.Mendeley appFind more chiropractic interviews at https://www.exploringchiropractic.comSUBSCRIBE:iTunes: www.exploringchiropractic.com/itunesStitcher: http://www.stitcher.com/podcast/exploring-chiropracticSpotify: https://open.spotify.com/show/54Ojmk2kjz5jG9n5DCZRxKGoogle Play Music: https://playmusic.app.goo.gl/?ibi=com.google.PlayMusic&isi=691797987&ius=googleplaymusic&link=https://play.google.com/music/m/Ipmyhflkvtnwtb23kyj7qrkgn5u?t%3DExploring_Chiropractic_Podcast%26pcampaignid%3DMKT-na-all-co-pr-mu-pod-16FOLLOW ME:Twitter: https://www.twitter.com/exploringchiroFacebook: https://www.facebook.com/exploringchiropracticInstagram: https://www.instagram.com/exploringchiro

John Mandrola, MD, presents an ACC 2021 recap. https://www.medscape.com/twic ACC 2021 Reveiw I -- Left Atrial Appendage Closure LAAOS III: Surgical LAA Closure Cuts AF Stroke Risk by One Third https://www.medscape.com/viewarticle/951232 - Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke https://www.nejm.org/doi/full/10.1056/NEJMoa2101897 Watchman Registry: 1-Year Stroke Estimates Reassuringly Low https://www.medscape.com/viewarticle/951235 II - Angiotensin-Neprilysin Inhibition PARADISE-MI: Sacubitril/Valsartan Can't Beat Ramipril in Patients With Acute MI https://www.medscape.com/viewarticle/951236 Life Trial Rationale Paper: https://doi.org/10.1016/j.jchf.2020.05.005 III - Renal Denervation Ultrasound Renal Denervation Drops BP in Patients on Triple Therapy https://www.medscape.com/viewarticle/951248 IV -- Clopidogrel vs ASA post Stent HOST-EXAM: Clopidogrel Beats Aspirin as Monotherapy After Stenting https://www.medscape.com/viewarticle/951294 - Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial https://doi.org/10.1016/S0140-6736(21)01063-1 V -- AF Ablation in HF RAFT-AF, Despite Itself, Hints at Advantage for Ablation Rhythm Control in Heart Failure With AF. https://www.medscape.com/viewarticle/951326 VI -- Rivaroxaban in COVID-19 – ACTION Trial Therapeutic Rivaroxaban Dose: Risk Outweighs Benefit in Stable COVID https://www.medscape.com/viewarticle/951475 VII -- REHAB-HF Trial Novel Rehab Program Fights Frailty, Boosts Capacity in Advanced HF https://www.medscape.com/viewarticle/951244 - Physical Rehabilitation for Older Patients Hospitalized for Heart Failure https://www.nejm.org/doi/full/10.1056/NEJMoa2026141 VIII – ASA 81 vs 325 – ADAPTABLE Trial ADAPTABLE: Low-Dose Aspirin as Good as High-Dose in CHD? https://www.medscape.com/viewarticle/951230 - Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease https://www.nejm.org/doi/full/10.1056/NEJMoa2102137 Perspectives: Eight Things to Know About the Surgical Left Atrial Appendage Occlusion (LAAOS III) Trial https://www.medscape.com/viewarticle/951229 PARADISE-MI Makes Me Question the Benefits of Sacubitril/Valsartan https://www.medscape.com/viewarticle/951239 Sacubitril/Valsartan: Trending Toward PARADISE Post MI https://www.medscape.com/viewarticle/950300 Renal Denervation for Resistant Hypertension Is Not Back on Track https://www.medscape.com/viewarticle/951497 Acute Alcohol Consumption Raises Risk for Atrial Fibrillation https://www.medscape.com/viewarticle/950938 Does ADAPTABLE Inform Aspirin Dosing for Secondary Prevention? https://www.medscape.com/viewarticle/950969 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Episode 49: Dementia in Primary Care. Dr Ryan Townley explains what to do when a patient reports “memory problems”, including labs, imaging, and more. Question of the month: Fever and Cough.Introduction: DementiaBy Hector Arreaza, MDToday is April 26, 2021.Dementia is an umbrella term that includes many conditions that have in common a cognitive decline affecting ADLs. It is an acquired condition that presents after the brain is fully developed. As our population ages, the topic of dementia has become more pertinent. Recently we had an introduction about the link between poor sleep and dementia, episode 42. The next two episodes will be about dementia.Today we would like to discuss further this relevant topic. We talked with Dr Ryan Townley, who is an assistant professor in the Department of Neurology at the University of Kansas Medical Center, and the director of the Cognitive and Behavioral Neurology Fellowship. We will discuss dementia screening, how to evaluate our patients who report “memory problems”, including additional testing and imaging, when to send to a neurologist or neuropsychologist, and some things we can do for prevention of dementia. This episode is not intended to be a comprehensive lecture about dementia, but it may motivate you to keep learning about this topic. I hope you enjoy it.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.  Question of the MonthWritten by Hector Arreaza, MD, read by Terrance McGill, MDThis is a 69-yo male patient, with controlled hypertension. He comes to an urgent care clinic for acute onset of fever (102 F), cough, and shortness of breath which has progressively worsened over the last 3 days. He does NOT smoke tobacco, but smokes recreational marijuana once a month, and drinks 1-2 beers a week. He goes to the doctor once a year for check-ups. He takes benazepril 10 mg daily for his hypertension. He does not believe in vaccines and his last shot was a tetanus shot 5 years ago. No surgical history. He retired as an accountant 5 years ago. Vital signs are normal except for tachycardia of 110 (his baseline is 85) and temperature of 101.5 F (38.6 C). He has bibasilar crackles on auscultation. You perform labs in clinic and he has a white count of 13.5, and a chest x-ray shows a right lower lobe consolidation. He has a negative rapid COVID-19 test. What are your top 3 differential diagnoses and what is the acute management of this patient’s condition?Let’s repeat the question: What are your top 3 differential diagnoses and what is the acute management of a 69-year-old male, non-smoker, who has fever, cough, shortness of breath, tachycardia, bibasilar crackles, elevated WBCs, a right lower lobe consolidation, and a negative rapid COVID-19 test?Send us your answer before May 7, 2021, to rbresidency@clinicasierravista.org and the best answer will win a prize!____________________________Dementia in Primary Care. With Ryan Townley, MD, and Hector Arreaza, MD.Ryan Townley, M.D., is an assistant professor in the Department of Neurology at the University of Kansas Medical Center and is the director of the Cognitive and Behavioral Neurology Fellowship. He is also the Alzheimer's Clinical Trials Consortium Associate Director and Primary Investigator at the University of Kansas Alzheimer's Disease Center. Dr. Townley is certified by the American Board of Psychiatry and Neurology. He joined the KU Medical Center faculty in August 2019. Prior to medical school, he earned a bachelor of science in neurobiology from the University of Kansas. He graduated from the University of Kansas School of Medicine, where he earned the 2013 Dewey K. Ziegler Award for Excellence in Neurology presented by the KU Department of Neurology and was honored with the American Academy of Neurology's Outstanding Neurology Medical Student Award. He then completed his neurology residency, an internal medicine internship, and a two-year cognitive behavioral fellowship at the Mayo Clinic School of Graduate Medical Education. He is the author of many publications and has presented more than two dozen lectures and posters nationally and around the world. His clinical and research interests include atypical Alzheimer's diseases, normal pressure hydrocephalus, frontotemporal lobar degeneration and dementia with Lewy bodies. He also has interests in patient, resident and medical student education, and preventative health against neurodegenerative disease.Questions discussed during this episode:What to do when someone complains of "memory problems" in primary care?When should a primary care doctor refer a patient to Neurology for evaluation of dementia?Dementia vs Normal aging. What are the types of dementia?When should a primary care doctor start medications for Alzheimer's disease? First-line pharmacologic treatment of Alzheimer's disease. Prevention of Alzheimer's disease:    Resources mentioned in this episode:AD8 Dementia Screening Interview: It is a tool given to an informant (ideally) or to the patient. It can be self-administered or administered by someone in clinic or by phone.AD8 in English: https://www.alz.org/media/Documents/ad8-dementia-screening.pdfAD8 in Spanish: https://championsforhealth.org/wp-content/uploads/2017/01/AD8-Screening-Spanish.pdf Mini-Cog: It is a 3-minute instrument that can increase detection of cognitive impairment in older adults. It can be used effectively after brief training in both healthcare and community settings. It consists of two components, a 3-item recall test for memory and a simply scored clock drawing test. It does not substitute for a complete diagnostic workup.Mini-Cog in English: http://mini-cog.com/wp-content/uploads/2018/03/Standardized-English-Mini-Cog-1-19-16-EN_v1-low-1.pdfMini-Cog in Spanish: http://mini-cog.com/wp-content/uploads/2018/03/SPANISH-Mini-Cog.pdf Montreal Cognitive Assessment (MoCA): Dementia screening tool, no longer free, it requires training and certification. Available in several languages: https://www.mocatest.org/ Saint Louis University Mental Status Examination (SLUMS): Screening tool for dementia, training advised and available for free, available in Epic.Training video: https://www.youtube.com/watch?v=z4ctoWU-qzwSLUMS in English: https://health.mo.gov/seniors/hcbs/hcbsmanual/pdf/4.00appendix8slumsform.pdfSLUMS in Spanish: https://www.slu.edu/medicine/internal-medicine/geriatric-medicine/aging-successfully/pdfs/spanish-pr.pdf Short Test of Mental Status, The University of Oklahoma Health Science Center, https://www.ouhsc.edu/age/Brief_Cog_Screen/documents/STMS.pdfDementia prevention, intervention, and care: 2020 report of the Lancet Commission, The Lancet, Vol 396, Issue 10248, P413-446, AUGUST 08, 2020. https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext Dementia Update Course: July 23, 2021, and September 3, 2021. Register at: https://www.eeds.com/portal_live_events.aspx?ConferenceID=634196____________________________ Conclusion.Now we conclude our episode number 49 “Dementia in Primary Care”, Dr Ryan Townley explained different tools we have to assess patients with “memory problems” and explained some interesting concepts in the assessment of cognitive impairment. Talking about dementia, don’t forget to answer our question of the month. Send us your top 3 differential diagnosis and acute management of a 69-year-old male with fever, cough, tachycardia, and right lower lobe consolidation. Send your answer before May 7, 2021, and win a prize! Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Ryan Townley, Ariana Lundquist, and Terrance McGill. Audio edition: Suraj Amrutia. See you next week! 

Aspirgillosis is a deadly fungal infection that is a major cause of mortality in pateints with impaired immune systems. The current standard of care has been voriconazole due to the favorable side effect profile compared to amphotericin. However, posaconazole may not have there adverse effects and be a reasonable course of therapy. Is voriconazole just just a phase? Reference: Maertens JA, Rahav G, Lee DG, et al. Posaconazole versus voriconazole for primary treatment of invasive aspergillosis: a phase 3, randomised, controlled, non-inferiority trial. Lancet. 2021 Feb 6;397(10273):499-509. doi: 10.1016/S0140- 6736(21)00219-1. PMID: 33549194. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 63, Issue 4, 15 August 2016, Pages e1–e60, hMps://doi.org/10.1093/cid/ciw326 CPE details for GameChangers Podcast March 2021 Learning Objective: Develop appropriate treatment of aspergillosis infections based on clinical studies. 0107-0000-21-097-H01-P 0.25 CEU/2.5 Hrs (Knowledge) Initial Release Date: 03/02/21 Expiration Date: 03/02/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information.

Aspirgillosis is a deadly fungal infection that is a major cause of mortality in patients with impaired immune systems. The current standard of care has been voriconazole due to the favorable side effect profile compared to amphotericin. However, posaconazole may not have there adverse effects and be a reasonable course of therapy. Is voriconazole just just a phase? Today's episode is sponsored by a special CEimpact FREE Law focused webinar:  Save your spot - FREE LIVE LAW CE webinar on April 1st.  SPOTS ARE LIMITED! https://ceimpact.com/law  Reference: Maertens JA, Rahav G, Lee DG, et al. Posaconazole versus voriconazole for primary treatment of invasive aspergillosis: a phase 3, randomised, controlled, non-inferiority trial. Lancet. 2021 Feb 6;397(10273):499-509. doi: 10.1016/S0140- 6736(21)00219-1. PMID: 33549194. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 63, Issue 4, 15 August 2016, Pages e1–e60, hMps://doi.org/10.1093/cid/ciw326 CPE details for GameChangers Podcast March 2021 Learning Objective: Develop appropriate treatment of aspergillosis infections based on clinical studies. 0107-0000-21-097-H01-P 0.25 CEU/2.5 Hrs (Knowledge) Initial Release Date: 03/02/21 Expiration Date: 03/02/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information.

Welcome to EndoPod's Revision Series! Each episode will cover bitesize revision material for those preparing for exams or even just for those who are interested in learning the basics of Endocrinology. This episode covers hyperthyroidism or an overactive thyroid gland. Voice - Hepsi Xavier Transcript - Tejaswi Sharma Editor - Serena Shoker Aberdeen University Endocrinology Society are a student lead organisation. All information provided in this podcast are intended for educational purposes. This podcast is not intended to replace the advice of a qualified health professional. The students involved in the making of this episode are in the 1st and 3rd year of their medical education. Resources: https://geekymedics.com/thyroid-function-test-tft-interpretation/ De Leo, Simone et al. “Hyperthyroidism.” Lancet (London, England) vol. 388,10047 (2016): 906-918. doi:10.1016/S0140-6736(16)00278-6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014602/ https://cks.nice.org.uk/topics/hyperthyroidism/diagnosis/assessment/ University of Aberdeen - Y2 MBChB Lecture - Thyroid Gland Physiology by Dr Alison Jack University of Aberdeen - Y2 MBChB Lecture - Clinical Thyroid Disease by Dr Prakash Abraham

In today's episode of Critical Matters, we will discuss the use of Extracorporeal Life Support (ECLS) in the form of extracorporeal membrane oxygenation (ECMO) for the treatment of the sickest patients with COVID-19 induced ARDS. Our guest is Dr. Jenelle Badulak. Dr. Badulak is an emergency physician and intensivist caring for patients in the Emergency Department, Cardiothoracic Intensive Care Unit, Medical Intensive Care Unit and Trauma Intensive Care Unit at the University of Washington Medical Center and Harborview Medical Center. She is a clinician-educator who specializes in curriculum development and assessment with a focus on graduate medical education and Extracorporeal Life Support/Extracorporeal Membrane Oxygenation (ECMO). Additional Resources: Extracorporeal Membrane Oxygenation Support in COVID-19: An International Cohort Study of the Extracorporeal Life Support Organization Registry: https://www.thelancet.com/article/S0140-6736(20)32008-0/fulltext Extracorporeal Life Support Organization(ELSO) COVID-19 Dashboard and Website: https://www.elso.org/Registry/FullCOVID19RegistryDashboard.aspx Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: A Retrospective Cohort Study: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30328-3/fulltext Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: https://www.nejm.org/doi/full/10.1056/NEJMoa1800385 Books Mentioned in this Episode: Extracorporeal Life Support: The ELSO Red Book: https://www.elso.org/Publications/RedBook5thEdition.aspx

This Beat episode, featuring Joel Dunning, MD, focuses on survivors' longitudinal functional status of ECMO after COVID-19, a trial on advanced reperfusion strategies, an analysis on the decrease in all adult surgeries, and results of robotically-assisted congenital cardiac surgery. For more information on this episode's topics, links are provided:What Does Survival Look Like After ECMO for COVID-19? Small registry highlights need to analyze survivors' longitudinal functional statushttps://www.medpagetoday.com/meetingcoverage/sts/90972Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trialhttps://www.thelancet.com/article/S0140-6736(20)32338-2/fulltextAn analysis of national data revealed a 53% decrease in all adult heart surgeries, including a 40% decline in non-elective heart surgeries and a 65% drop in elective heart surgeries during the pandemic, compared to 2019.https://consumer.healthday.com/b-2-2-pandemic-has-cut-heart-surgeries-in-half-and-more-patients-are-dying-2650177681.html   https://www.ctsnet.org/article/totally-endoscopic-transaortic-septal-myectomy-hypertrophic-cardiomyopathyEarly Results of Robotically Assisted Congenital Cardiac Surgery: Analysis of 242 Patients : JANS postinghttps://www.ctsnet.org/jans/early-results-robotically-assisted-congenital-cardiac-surgery-analysis-242-patients

Class is in session! A note from Spencer: If you aren’t already aware this episode is my last episode as the 30% fact spitting Blazed University cohost. I have had such a beautiful time putting this dream together with Alley and I’m so excited to see how she and her new cohost will grow it. In this farewell episode we talk about one of my favorite topics PLANTS, and Alley gives us a history lesson that not many people know about the dancing plagues of Europe. Tune in! And if you love the episode please rate, review, and share!! Resources:https://www.prestigiousplantscapes.com.au/9-surprising-facts-about-indoor-plants/ https://www.ndsu.edu/pubweb/chiwonlee/plsc211/student%20papers/articles11/mpritchett/asexualprop.htmlhttps://www.fieldnotesbystudioplants.com/houseplants/how-to-do-water-propagationhttps://www.gardeningknowhow.com/garden-how-to/propagation/propgen/types-of-plant-propagation.htm https://www.thelancet.com/article/S0140-6736(09)60386-X/fulltexthttps://en.wikipedia.org/wiki/Dancing_maniahttps://www.smithsonianmag.com/smart-news/strange-case-dancing-mania-struck-germany-six-centuries-ago-today-180959549/https://www.history.com/news/what-was-the-dancing-plague-of-1518Check us out on social media: Instagram- www.instagram.com/blazeduniversityTik Tok-@BlazeduniversityFacebook- www.facebook.com/blazeduniversityFor sponsorship opportunities email Blazeduniversity@gmail.com

Daniel Griswold is a senior affiliated scholar at the Mercatus Center and a nationally recognized expert on trade and immigration policy. Dan is also a returning guest is to the podcast, and joins Macro Musings to talk about immigration policy and the outlook for trade policy with the new Biden Administration. Specifically, David and Dan discuss the major demographic decline in the US, and how greater levels of immigration and can solve many of America’s economic concerns.    Transcript for the episode can be found here: https://www.mercatus.org/bridge/tags/macro-musings   Dan’s Twitter: @danielgriswold Dan’s Mercatus profile: https://www.mercatus.org/scholars/daniel-griswold   Related Links:   *More Immigration Needed to Offset COVID-19 and America’s Demographic Decline* by Daniel Griswold https://www.mercatus.org/publications/trade-and-immigration/more-immigration-needed-offset-covid-19-and-america%E2%80%99s-demographic   *Half a Million Fewer Children? The Coming COVID Baby Bust* by Melissa Kearney and Phillip Levine https://www.brookings.edu/research/half-a-million-fewer-children-the-coming-covid-baby-bust/   *World Population Prospects 2019: Highlights* by the Department of Economic and Social Affairs, Population Division at the United Nations https://population.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf   *The Next Hundred Million: America in 2050* by Joel Kotkin https://www.penguinrandomhouse.ca/books/298866/the-next-hundred-million-by-joel-kotkin/9781101195703   *Fertility, Mortality, Migration, and Population Scenarios for 195 Countries and Territories from 2017 to 2100: A Forecasting Analysis for the Global Burden of Disease Study* by Stein Emil Vollset et al. https://www.thelancet.com/article/S0140-6736(20)30677-2/fulltext   *Clashing over Commerce: A History of US Trade Policy* by Douglas Irwin https://press.uchicago.edu/ucp/books/book/chicago/C/bo24475328.html   David’s blog: macromarketmusings.blogspot.com David’s Twitter: @DavidBeckworth

In this 65th in a series of live discussions with Bret Weinstein and Heather Heying (both PhDs in Biology), we discuss the state of the world through an evolutionary lens. In this episode, we begin by offering gratitude to Bill Maher and his crew for having us on on January 29—but why didn’t Heather answer his question about vaccines? She does so here, and we discuss a bit more about vaccine technology (also see episode 58 for more on that). Next: What does consensus look like in science, and when are we looking at forced consensus, one which may not accurately reflect underlying reality? What does this have to do with the “lab leak hypothesis” regarding the origin of SARS-CoV2? Following that: how does diet affect COVID—either in terms of mitigating risk of contracting it, or of reducing symptoms if you have it? Short advice: eat more ferment, and buy local. We finish by talking about tuna, and sea stars. DarkHorse merchandise now available at: store.darkhorsepodcast.org Find more from us on Bret’s website (https://bretweinstein.net) or Heather’s website (http://heatherheying.com). Become a member of the DarkHorse LiveStreams, and get access to an additional Q&A livestream every month. Join at Heather's Patreon. Like this content? Subscribe to the channel, like this video, follow us on twitter (@BretWeinstein, @HeatherEHeying), and consider helping us out by contributing to either of our Patreons or Bret’s Paypal. Looking for clips from #DarkHorseLivestreams? Here are some, updated frequently: @DarkHorse Podcast Clips Theme Music: Thank you to Martin Molin of Wintergatan for providing us the rights to use their excellent music. Q&A Link: https://youtu.be/WIC3sx4F2Qg Mentioned in this episode: Dolgin 2020. COVID-19 vaccines poised for launch, but impact on pandemic unclear. https://www.nature.com/articles/d41587-020-00022-y Butler 2015. Engineered bat virus stirs debate over risky research. https://www.nature.com/news/engineered-bat-virus-stirs-debate-over-risky-research-%201.18787?utm_medium=affiliate&utm_source=commission_junction&utm_campaign=3_nsn6445_deeplink_PID100072647&utm_content=deeplink Relman 2020. Opinion: To stop the next pandemic, we need to unravel the origins of COVID-19. https://www.pnas.org/content/pnas/117/47/29246.full.pdf Karesh et al 2012. Ecology of zoonoses: natural and unnatural histories. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2812%2961678-X Bousquet et al 2020. Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19. https://pubmed.ncbi.nlm.nih.gov/32762135/ Bousquet et al 2020. Is diet partly responsible for differences in COVID-19 death rates between and within countries? https://ctajournal.biomedcentral.com/articles/10.1186/s13601-020-00323-0?fbclid=IwAR3ljFDFU6cI9Hg_NwvKFdPF6YhvRWGYiq2ddtNuSYfrJTUJ539V3Ml5Mvo Rishi et al 2020. Diet, Gut Microbiota and COVID-19. https://pubmed.ncbi.nlm.nih.gov/33012868/ Iddir et al 2020. Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. https://pubmed.ncbi.nlm.nih.gov/32471251/ There’s no tuna in my tuna! https://www.washingtonpost.com/food/2021/01/27/subway-tuna-lawsuit/ Support the show (https://www.patreon.com/bretweinstein)

Overview: This episode reviews the current news updates of this pandemic as well as recently updated guidelines and medical literature. It also includes perspectives from a Yale site PI for the Pfizer vaccine and rolling out the vaccine in hospital systems. Speakers: - Gopi Patel, MD, MS, FIDSA - Onyema Ogbuagu, MBBCh, FACP, FIDSA - Waleed Javaid, MD (moderator) - Cindy Prins, PhD, MPH, CIC, CPH (news update) Sources from news update: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932656-8 https://www.thelancet.com/journals/lancet/article/PIIS0140-67362032656-8/fulltext https://www.biorxiv.org/content/10.1101/2021.01.07.425740v1.full Are we meeting your podcast needs? Please fill out the short feedback form to let us know at https://learningce.shea-online.org/content/shea-podcast-feedback New Members can now receive 50% off 2021 SHEA Membership by using the Coupon Code: Welcome2021 until March 31

Amy and Jen discuss the efficacy (and what that percentage ACTUALLY means, in terms of the stats), safety and mechanisms of the three vaccines currently approved for use in the UK at the time of recording - The Oxford-AstraZenaca, Moderna-NIAID and the BioNtech-Pfizer. We also talk about some worries that either you might be having about these vaccines or that you might come across from families in your practice over the next few weeks and months. As ever, fear is born of a lack of understanding. Some of this science is new, but despite that there is much we do know and much that we can say with confidence. If you have a worry we have not covered - we want to hear from you. Please don't be shy - if you have thought it there will certainly be plenty of others worrying the same things. Questioning and thinking about these things demonstrates that we are scientifically minded and keen to interrogate the data. So speak up and we can work it out together as a community. Email us at iamahealthvisitor@gmail.com. Thankyou for all your incredible work, both inside and outside of a pandemic. Health visitors are superheroes. Amy and Jen xxx Resources and Further Reading: COVID19 chapter in the Green Book: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948757/Greenbook_chapter_14a_v4.pdf Clear explanation on different types of vaccines and how they work: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html The Oxford-AstraZenaca Trial Data: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932661-1 The Pfeizer-BioNTech Trial Data: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2034577?articleTools=true The Moderna-NIAID Trial Data: https://www.nejm.org/doi/full/10.1056/NEJMoa2035389 Drugs in Breastmilk Service (Breastfeeding Network) Info on the COVID vaccines: https://www.breastfeedingnetwork.org.uk/coronavirus/ WHO guidance on pregnancy and COVID: https://www.who.int/news/item/01-09-2020-new-research-helps-to-increase-understanding-of-the-impact-of-covid-19-for-pregnant-women-and-their-babies November 2020 BMJ study of COVID in pregnancy: https://www.bmj.com/content/370/bmj.m3320 Panorama BBC episode ‘the race for a vaccine’. https://www.bbc.co.uk/iplayer/episode/m000qdzd/panorama-the-race-for-a-vaccine E-Learning for Healthcare: https://www.e-lfh.org.uk/programmes/covid-19-vaccination/ Oxford Vaccine Group FAQs: https://www.research.ox.ac.uk/Article/2020-12-30-oxford-vaccine-regulatory-faq WHO description of how vaccines work: https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work?utm_source=facebook&utm_medium=landingpageviews&utm_campaign=vaccinebls&fbclid=IwAR1H5aAE-KZTfzLrEqzkxKQAH4BDd-UsFo_BcH4dP3C67CifXkQJwBy3LB0 Interesting discussion on vaccine hesitancy: https://www.ox.ac.uk/news/science-blog/covid-19-vaccine-hesitancy-uk

Sí, ya todos sabemos que el alcohol va a dañar tu hígado, que es un depresivo, pero lo más probable es que no sepas los verdaderos riesgos para quienes pensamos que no tiene nada de malo tomar sin embriagarse.Este es el último episodio del año, y esta es la época en la que más veo gente alcoholizada, la época en la que hay más accidentes relacionados al alcohol y es para mi de vital importancia levantar la voz sobre este tema, un tema muy sensible para mi.Espero que te sirva y que se lo compartas a quien necesite entender esto. Te dejo el link de la cuenta @1000hoursdryTe motivo a que no esperes a que llegue el año nuevo para mejorar tu salud. Esto es algo importante, tu cuerpo te lo va a agradecer.Estudio: https://www.thelancet.com/article/S0140-6736(18)31571-X/fulltext#back-bib6Vane info@conscienciafertil.com

Dr Evanguelos Xylinas : POUT versus URANUS : Faut-il proposer une chimiothérapie périopératoire chez les patients atteints de tumeur des voies excrétrices supérieures ?Quel est le rationnel des chimiothérapies adjuvantes et néoadjuvantes ? Quelles sont les données de la chimiothérapie néoadjuvante ? Quelles sont les données de la chimiothérapie adjuvante ?Le Dr Evanguelos Xylinas (CHU Bichat, Paris) répond à toutes vos questions !L’orateur n’a pas reçu de rémunération pour la réalisation de cet épisode.Pour aller plus loin : Essai POUT :Birtle A, Johnson M, Chester J, Jones R, Dolling D, Bryan RT, Harris C, Winterbottom A, Blacker A, Catto JWF, Chakraborti P, Donovan JL, Elliott PA, French A, Jagdev S, Jenkins B, Keeley FX Jr, Kockelbergh R, Powles T, Wagstaff J, Wilson C, Todd R, Lewis R, Hall E. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial. Lancet. 2020 Apr 18;395(10232):1268-1277. doi: 10.1016/S0140-6736(20)30415-3. Epub 2020 Mar 5. PMID: 32145825; PMCID: PMC7181180.Essai URANUS :Palou J, Maroto P, Osanto S, Bellmunt J, Beisland C, Roupret M. Neo-adjUvant veRsus AdjuvaNt chemotherapy in upper tract Urothelial carcinoma: A feaSibility phase II randomized clinical trial (“URANUS”). European Urology Supplements. 1 mars 2019;18(1):e1847. https://www.eu-openscience.europeanurology.com/article/S1569-9056(19)31338-7/pdfCet épisode a été réalisé grâce au soutien institutionnel du Laboratoire Janssen.Musique du générique : Via AudioNetworkResponsable projet AFUF : Dr Benjamin PradèreProduction : La Toile Sur Ecoute See acast.com/privacy for privacy and opt-out information.

Pr Alexandre de la Taille : Cancer de prostate oligométastatique : définition, traitement actuel et futurQuelle est la définition d’un cancer de prostate oligométastatique d’emblée ? Quel est l’intérêt d’un traitement local ? Pourquoi ne pas traiter à la fois la prostate et les métastases ?Le Pr Alexandre de la Taille (CHU Henri Mondor, Créteil) répond à toutes vos questions !L’orateur n’a pas reçu de rémunération pour la réalisation de cet épisode.Pour aller plus loin :Boevé LMS, Hulshof MCCM, Vis AN, Zwinderman AH, Twisk JWR, Witjes WPJ, Delaere KPJ, Moorselaar RJAV, Verhagen PCMS, van Andel G. Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial. Eur Urol. 2019 Mar;75(3):410-418. doi: 10.1016/j.eururo.2018.09.008. Epub 2018 Sep 25. PMID: 30266309.Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A, Ritchie AWS, Attard G, Chowdhury S, Cross W, Dearnaley DP, Gillessen S, Gilson C, Jones RJ, Langley RE, Malik ZI, Mason MD, Matheson D, Millman R, Russell JM, Thalmann GN, Amos CL, Alonzi R, Bahl A, Birtle A, Din O, Douis H, Eswar C, Gale J, Gannon MR, Jonnada S, Khaksar S, Lester JF, O'Sullivan JM, Parikh OA, Pedley ID, Pudney DM, Sheehan DJ, Srihari NN, Tran ATH, Parmar MKB, Sydes MR; Systemic Therapy for Advanced or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) investigators. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet. 2018 Dec 1;392(10162):2353-2366. doi: 10.1016/S0140-6736(18)32486-3. Epub 2018 Oct 21. PMID: 30355464; PMCID: PMC6269599.Cet épisode a été réalisé grâce au soutien institutionnel des Laboratoires Bayer.« Certains données publiées peuvent ne pas avoir été validées par les autorités de santé françaises. La publication de ce contenu est effectué sous la seule responsabilité de l’éditeur et de son comité scientifique »Musique du générique : Via AudioNetworkResponsable projet AFUF : Dr Benjamin PradèreProduction : La Toile Sur Ecoute See acast.com/privacy for privacy and opt-out information.

In this episode, we explore the evidence on whether lower intraoperative tidal volumes (e.g., 6 vs. 9 cc/kg) reduce postoperative pulmonary complications. Our guest is Dr. Avery Tung. Dr. Tung is Professor of Anesthesia & Critical Care at the University of Chicago and Section Editor for Critical Care & Resuscitation for Anesthesia & Analgesia. Thanks for listening! If you enjoy our content, consider supporting our mission at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Karalapillai D, Weinberg L, Peyton P, et al. Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA. 2020;324(9):848–858. doi:10.1001/jama.2020.12866 Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8. doi: 10.1056/NEJM200005043421801. PMID: 10793162. Brower RG, Shanholtz CB, Fessler HE, Shade DM, White P Jr, Wiener CM, Teeter JG, Dodd-o JM, Almog Y, Piantadosi S. Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med. 1999 Aug;27(8):1492-8. doi: 10.1097/00003246-199908000-00015. PMID: 10470755. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998 Feb 5;338(6):347-54. doi: 10.1056/NEJM199802053380602. PMID: 9449727. Tobin MJ. Culmination of an era in research on the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1360-1. doi: 10.1056/NEJM200005043421808. PMID: 10793169. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, Damasceno MC, Schultz MJ. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012 Oct 24;308(16):1651-9. doi: 10.1001/jama.2012.13730. PMID: 23093163. Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin JE, Pereira B, Jaber S; IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013 Aug 1;369(5):428-37. doi: 10.1056/NEJMoa1301082. PMID: 23902482. Serpa Neto A, Hemmes SN, Barbas CS, Beiderlinden M, Biehl M, Binnekade JM, Canet J, Fernandez-Bustamante A, Futier E, Gajic O, Hedenstierna G, Hollmann MW, Jaber S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Putensen C, Ranieri M, Scavonetto F, Schilling T, Schmid W, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Gama de Abreu M, Pelosi P, Schultz MJ; PROVE Network Investigators. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis. Anesthesiology. 2015 Jul;123(1):66-78. doi: 10.1097/ALN.0000000000000706. PMID: 25978326. PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology, Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014 Aug 9;384(9942):495-503. doi: 10.1016/S0140-6736(14)60416-5. Epub 2014 Jun 2. PMID: 24894577; PMCID: PMC6682759. Marret E, Cinotti R, Berard L, Piriou V, Jobard J, Barrucand B, Radu D, Jaber S, Bonnet F; and the PPV study group: Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: a double-blind randomised controlled trial. Eur J Anaesthesiol 2018; 35:727–35 Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, Gajic O, El-Tahan MR, Ghamdi AA, Günay E, Jaber S, Kokulu S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Ranieri VM, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Amato MB, Costa EL, de Abreu MG, Pelosi P, Schultz MJ; PROVE Network Investigators. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016 Apr;4(4):272-80. doi: 10.1016/S2213-2600(16)00057-6. Epub 2016 Mar 4. Erratum in: Lancet Respir Med. 2016 Jun;4(6):e34. PMID: 26947624.

Support us on the Patreons! Did you see that Lancet article that says that all the world needs the rehabs?! So did we! Does this mean physical therapists are going to be swimming in business/money in the future? Or that we need to get a whole lot more efficient in what we do? Also, is this the end of PT Inquest??? [dramatic music] Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Alarcos Cieza, PhD; Kate Causey, BSc; Kaloyan Kamenov, PhD; Sarah Wulf Hanson, PhD; Somnath Chatterji, MD; Theo Vos, PhD. Lancet. 2020 Dec 01. doi: 10.1016/S0140-6736(20)32340-0. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission Other Music by Kevin MacLeod - incompetech.com: MidRoll Promo - Mining by Moonlight

We have a multitude of interviews for you this week. We start by interviewing Dr. Julia Marcus of the Harvard Medical School and Harvard Pilgrim Health Care Institute on messaging around public health interventions during the COVID-19 pandemic. We continue talking about COVID-19 with Anne Sosin and Dr. Elizabeth Carpenter-Song, both of Dartmouth College. They join us on the podcast to discuss how the Northeast region of the United States has uniquely handled COVID-19. Finally, we bring back the Journal Club with a Fellow segment and interview Dr. David Russler-Germain of Washington University School of Medicine in St. Louis on a new paper out now in The Lancet on CAR T-cell therapy in DLBCL: TRANSCEND NHL 001. TRANSCEND NHL 001: doi.org/10.1016/S0140-6736(20)31366-0 Back us on Patreon! www.patreon.com/plenarysession Check out our YouTube channel: www.youtube.com/channel/UCUibd0E2kdF9N9e-EmIbUew

In this episode, Judith and Erin consider how female academics have been impacted during COVID-19. The hosts survey the three arms of the academy (publishing, teaching, and service) from a feminist perspective to see how the massive changes due to COVID are impacting women in the academy.  This episode refers to the following articles:"The Virus Moved Female Faculty to the Brink. Will Universities Help?" By Jillian Kramer posted at https://www.nytimes.com/2020/10/06/science/covid-universities-women.html"Pandemic Imperils Promotions for Women in Academia" by Noam Scheiberposted at:  https://www.nytimes.com/2020/09/29/business/economy/pandemic-women-tenure.html?action=click&module=RelatedLinks&pgtype=Article Gabster, B. P., van Daalen, K., Dhatt, R., & Barry, M. (2020). Challenges for the female academic during the COVID-19 pandemic. Lancet (London, England), 395(10242), 1968–1970. https://doi.org/10.1016/S0140-6736(20)31412-4 posted at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302767/

Episode 29: OSA with Clau The sun rises over the San Joaquin Valley, California, today is September 25, 2020.As allopathic doctors, medications are our most potent tools to fight and prevent diseases. Today, we want to remind everyone about substance abuse and give you an update on a procoagulant agent. Substance abuse is a growing problem. Due to increased stress, anxiety, depression, and unemployment, drug abuse is on the rise during the current pandemic[1]. Some medications may not be considered a “drug of abuse” when prescribed alone, but they can be combined with other medications to cause a potentially addictive effect. Such is the case of promethazine[2,3], which is usually combined with codeine, dextromethorphan and  expectorants for cough. Promethazine is also used as an antiemetic, for procedural sedation, and for allergic reactions. Promethazine-containing products are abused for their sedative effects. Specifically, when promethazine is combined with opioids, it potentiates euphoria, alleviates withdrawal symptoms and relieves opioid-induced nausea. So, be aware of drugs that can potentially be misused or abused, even when they are not scheduled. Other examples include quetiapine, baclofen, gabapentin, fluoxetine, and more. Examples of OTC medications that can also be misused are diphenhydramine and loperamide.Now, let’s talk briefly about tranexamic acid. You may remember this medication as a treatment for menorrhagia, and to control bleeding in general. UptoDate stated in December 2019 that this medication is now recommended in patients with moderate Traumatic Brain Injury (TBI) presenting within 3 hours of the event[4]. Interestingly, tranexamic acid is a potent neurotoxin with a mortality rate of 50%, but ONLY when given accidentally via intraspinal route. Remember, it’s safe IV and oral, but NOT intraspinal. Survivors of intraspinal injection often experience seizures, permanent neurological injury, ventricular fibrillation, and paraplegia. Container mix-ups were involved in 3 recent cases[5]. So, this is why checking medication labels is critical._____________________________This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program, from Bakersfield, California. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care since 1971. “A life without a cause is a life without effect.” ― Paulo CoelhoThink about your purpose in life, what motivates you? Where do you want to be? Start now to direct your life to get you where you want to be. Claudia Carranza is here with us today, a Wednesday after didactics to discuss another topicWho are you? My name is Claudia Carranza; you might recognize my voice from the “Espanish word of the week”, I am a PGY3 resident in our Rio Bravo Family Medicine residency program. I am married to an internal medicine resident, we have 2 dogs and they keep us really busy going to the dog park, long walks and jogging.  What did you learn this week? This week I learned about obstructive sleep apnea (OSA). I actually had a patient recently with obstructive sleep apnea which persisted despite prior tonsillectomy. I also learned that obstructive sleep apnea in children can present with symptoms similar to ADHD. I thought, I definitely need to read more about management and I would like to focus mostly on pediatrics.  A lot of patients ask me: what is obstructive sleep apnea? And I would tell them in my own words that “it’s a condition in which something blocks your upper airway and it makes you sometimes snore and wake up multiple times at night because you are unable to breath”. A fancier definition is “a complete or partial upper airway obstruction which can result in gas exchange abnormalities”.  This doesn’t sound very pleasant and patients won’t necessarily come to you complaining that they are waking up at night. Instead, it can be presented to you as different complaints such as snoring, daytime sleepiness with car rides or at school, nocturnal enuresis, and in particular in children it can manifest as inattention, learning problems, hyperactivity, impulsivity, rebelliousness and even aggression. But wait; these last few symptoms sound a lot like attention deficit hyperactivity disorder or ADHD.  So here where SCREENING becomes very important, and usually you will ask your patient or their parent: does your child snore? More often than not the parents will know; sometimes I have even had a patient’s brother or sister in the room who says: “yes he/she snores!” Another part of your yearly check-ups will be looking at the oropharynx and you will see whether the patient has enlarged tonsils. Remember: not everyone who snores will have enlarged tonsils and not everyone who has enlarged tonsils will snore.  But any child who snores 3 or more nights per week, has loud snoring and has pauses in breathing should undergo a full diagnostic evaluation for Obstructive Sleep Apnea. Once you OSA has been diagnosed and treated it is still important to monitor children as they can have residual symptoms or recurrence. Look out for weight gain.  Question number 3: Why is that knowledge important for you and your patients? Not only can undiagnosed OSA lead to sometimes unnecessary ADHD treatment but it can also lead to failure to thrive if OSA is severe; cardiopulmonary problems including ventricular dysfunction, systemic HTN, endothelial dysfunction. It has also been associated to a lesser degree with pulmonary HTN.  Now that we know how serious OSA can be and that you need to order a full work up when it is suspected I want to quickly go over the next steps in clinic:Focused sleep history and physical exam including detailed oropharynx exam, close attention to blood pressure, BMI, craniofacial abnormalities, shape of mouth/palate/jaw and size of tonguePolysomnography (PSG) or referral to a specialist such as ENT or sleep medicine for further evaluation and treatment For those of us in Family medicine, treating adult patients, keep in mind that children and adults have different risk factors to look out for: Risk factors of pediatrics sleep apnea in children: Adenotonsillar hypertrophy and obesity (in otherwise healthy children). If OSA appears in infancy the child likely has anatomic or genetic abnormality. Risk factors of OSA in adults: older age, male sex, obesity, craniofacial and upper airway abnormalities (short mandibular size, wide craniofacial base and tonsillar and adenoid hypertrophy. How did you get that knowledge? I think the more patients I see the more knowledge I accumulate and it comes from a combination of sources like my attendings, UptoDate and my fellow residents. Where did that knowledge come from?I read Uptodate, and article from Thorax titled “Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study” Tal et al, which showed that children with OSA had significant elevation in BP both while sleeping and awake. Also, “Diagnosis and management of childhood obstructive sleep apnea syndrome” published on Pediatrics. _______________________________Speaking Medical: Adventitious Breath Soundsby Xeng Xai Xiong, MS3Hey, what’s cooking?  Did you hear that? It was the sound of bacon sizzling in the fresh cozy morning. Now, this is the sound of the sound of fine crackles coming from the lungs.  I’m not sure whether hearing sizzling bacon reminds me of fine crackles of the lungs [delete repeated sentence] or fine crackles of the lungs remind me of bacon. Either way, you would agree that bacon tastes good.  I am getting too carried away with this now so I’m going to jump straight to the point. As a medical student, it was intimidating to differentiate the different lung sounds. Maybe I need an ear check, or maybe I haven’t listened to enough lungs. The latter sounds more probable since the first two years of medical school was spent listening to standardized patients' lungs.  Today, I’m going to share with you four of the most common abnormal lung sounds. But before we talk about the abnormal, let’s review the vesicular breath sound, which is the normal breath sound, just in case you forgot about it: https://www.youtube.com/watch?v=VtnMRG0ORLs Wheezing is a high-pitched whistling noise that can happen on inspiration or expiration. It’s usually a sign that something is making your airways narrow or keeping air from flowing through them. Although there can be many things that cause wheezing, two of the most common causes are chronic obstructive pulmonary disease and asthma. Here is a sound bite of expiratory wheezing: 1:50-1:57 https://www.youtube.com/watch?v=KRtAqeEGq2Q Stridor is a harsh, noisy, squeaking sound that happens with every breath. It can be high or low, and it’s usually a sign that something is blocking your airways. It can be heard in laryngomalacia, croup, and more. Here is an example of stridor: 3:03-3:11 https://www.youtube.com/watch?v=KRtAqeEGq2Q. Crackles (rales) is a series of short, explosive sounds. They can also sound like bubbling, rattling, or clicking. You can have fine crackles, which are shorter and higher in pitch, or coarse crackles, which are lower. Either can be a sign that there’s fluid in the air sacs. Here is the sound of a course crackling (0:55-1:01 https://www.youtube.com/watch?v=KRtAqeEGq2Q). Here are fine crackles (1:08-1:15) Rhonchi is a low-pitched wheezing sounds sound like snoring and usually happen when you breathe out. They can be a sign that your bronchial tubes are thickening because of mucus. Rhonchi sounds can be a sign of bronchitis or COPD. Here is the sound of rhonchi (2:35-2:43). For your undivided attention, here is a bonus lung sound (silent for 3 seconds). Yep, that was an absent lung sound; it can mean air or fluid in or around the lungs such as pleural effusion or pneumothorax. Lung sounds can be intimidating at first, but they can be easily differentiated if you spend some time to study them. That’s it for now hasta la vista baby.____________________________Espanish Por Favor: Dormir by Claudia CarranzaThis is Dr Carranza again bringing you the “Espanish word of the week”. This week’s word is “Dormir”. Dormir is one of our favorite activities, especially when we are tired; for any residents out there “Dormir” must sound very appealing, especially after a long shift. “Dormir” comes from the latin word “dormire” which means Sleep or rest.  Since we just talked about sleep apnea, one important question you can ask your patient is “ senor, puede DORMIR bien en la noche” which means “ sir, do you sleep well at night?”.  A different question you can ask is “Señor, ¿tiene problemas para DORMIR?” which means, “sir, do you have difficulty sleeping?”. Also remember that if you want to ask about their child you can replace the “señor” with “su niño”. Now you know the Spanish work of the week “DORMIR.” Have a great weekend!____________________________For your Sanity: Define mittleschmerzby Dr Steven Saito and Dr Sally WonderlyDr Three pregnant women were waiting in the doctor’s waiting room for an antenatal check-up and were all knitting garments for their respective babies.Suddenly the first expectant mother stops knitting, checks her watch, pulls a bottle of pills from her handbag and takes one."What was that?", the other two ask, curiously."Calcium tablet. Good for mommy, good for baby", she replies, patting her stomach affectionately.Satisfied, all three continue with their knitting. Five minutes later, the second one stops knitting, checks her watch, takes a bottle of pills from her handbag and takes one."What was that?", the other two enquire."Vitamin tablet", she replies, “Good for mommy, good for baby" and she pats her stomach affectionately.All three smile and continue busily with their knitting. Five minutes later, the last woman stops knitting, checks her watch, takes a bottle of pills from her handbag and takes one."What was that?" ask the other two."Thalidomide. I can’t knit sleeves." Dr Arreaza: Thalidomide was a teratogenic medication linked to phocomelia, or congenital malformation of the limbs)Dr Wonderly: Listen up! Today we have a gift for those who believe that learning is not only fun, but can also bring rewards. Yes, this time we want to reward the listener who sends the most creative definition of mittleschmerz. Yes, mittleschmerz is used in English too. Your definition of mittleschmerz will be used in our next episode of Rio Bravo qWeek. Type your definition of mittleschmerz, keep it brief and interesting, maybe 1 or 2 paragraphs, and send it to rbresidency@clinicasierravista.org ASAP. Looking for your five minutes of fame? Well, you can also record your definition of mittleschmerz for our next episode. Don’t send an audio, let us know if you want to record it and we will give you a call. ___________________________________Now we conclude our episode number 29 “OSA with Clau.” Dr Carranza reminded us to think about Obstructive Sleep Apnea in kids as part of the work up of ADHD. Xeng eloquently explained the four most common adventitious breath sounds, and reminded us that crackles may sound like sizzling bacon. Claudia then explained what you want to do after your night shift, dormir, which means sleep. Don’t forget our contest. Send your definition of mittleschmerz to rbresidency@clinicasierravista.org, and if you want to record it, we’ll give you a call.Conclusion: Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Golriz Asefi, Claudia Carranza, Mariel Chan, Xeng Xiong, Sally Wonderly and Steven Saito. Audio by Suraj Amrutia. See you next week! _____________________References:Sparkman, David, Drug Abuse on the Rise Because of COVID-19, EHS Today, August 29, 2020, https://www.ehstoday.com/covid19/article/21139889/drug-abuse-on-the-rise-because-of-the-coronavirus Promethazine Abuse: A Growing Problem? Tox Tid Bits, Maryland Poison Center, University of Maryland School of Pharmacy, March 2017, https://www.mdpoison.com/media/SOP/mdpoisoncom/ToxTidbits/2017/March%202017%20ToxTidbits.pdf Klein-Schwartz, Wendy, PharmD, MPH, et al, Abuse of Nonscheduled Medications and Nonprescription Drugs, American College of Medical Toxicology, Online Library, https://www.acmt.net/_Library/2019_Israeli_Conference/Non-prescription_-_Klein.pdf Eichler, April F, MD, MPH, and Sadhna R Vora, MD, Practice Changing UpDates, Up to Date, https://www.uptodate.com/contents/practice-changing-updates, Last updated: Sep 09, 2020. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial, The Lancet, Vol 394, Issue 10210, P1713-1723, November 09, 2019, Open Access Published: October 14, 2019, DOI: https://doi.org/10.1016/S0140-6736(19)32233-0   National Alert Network, Dangerous wrong-route errors with tranexamic acid,  https://www.ismp.org/sites/default/files/attachments/2020-09/NAN%20Alert%2020200909.pdf, accessed on Sep 24, 2020. Paruthi, Shalini, MD, et al, Evaluation of suspected obstructive sleep apnea in children, UptoDate, Last updated: Mar 19, 2020, https://www.uptodate.com/contents/evaluation-of-suspected-obstructive-sleep-apnea-in-children?search=osa%20children&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 Li AM, Au CT, Sung RYT, et al, Ambulatory blood pressure in children with obstructive sleep apnoea: a community based study, Thorax 2008;63:803-809. https://thorax.bmj.com/content/63/9/803 Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, Pediatrics April 2002, 109 (4) 704-712; https://pediatrics.aappublications.org/content/109/4/704 Robinson, Jennifer, MD, “Lung Sounds: What Do They Mean?” WebMD Medical Reference, reviewed on June 12, 2020, https://www.webmd.com/lung/lung-sounds, accessed on Sep 16, 2020.  Audio of sizzling bacon, courtesy of http://www.texashighdef.net, courtesy of yogaduke YouTube Channel, https://www.youtube.com/watch?v=e-5GirZe_jY Audio of lung sounds, courtesy of EMTPrep YouTube Channel: https://www.youtube.com/watch?v=KRtAqeEGq2Q  

With so many companies developing vaccines for the coronavirus the media is a frenzy with information, but what does any of it mean? We talked in the past about the development of the vaccine and started to get a sense of what might be different as far as information with the Russian development. Join hosts Shanti and Danny as we bring back special guest Dr. Bryan Simons to discuss what may be the most important episode of this podcast to date. A real-time analysis of the research conducted in Russia, the data that’s been released, and what it truly means.ReferencesLogunov, D., et. al.; Safety and Immunogenicity of an rAd26 and rAd5 Vector-Based Heterologous Prime-Boost COVID-19 Vaccine in Two Formulations: Two Open, Non-randomised Phase ½ Studies from Russia. The Lancet. 04-Sep-2020. Doi: https://doi.org/10.1016/S0140-6736(20)31866-3Bucci, E.; Note of Concern: Open Letter to DY Logunov et. al.,. Cattivi Scienziati. 07-Sep-2020. https://cattiviscienziati.com/2020/09/07/note-of-concern/Parodi, E.; Scientists from 5 Countries Question Accuracy of Russia Coronavirus Vaccine Data. 15-Sep-2020. Global News Canada. https://globalnews.ca/news/7335548/russia-coronavirus-vaccine-lancet/

We start this week's episode by critically examining the new paper titled "Racial/Ethnic Variation in Nasal Gene Expression of Transmembrane Serine Protease 2 (TMPRSS2)" and asking, is it racist? After that, we discuss advances in prostate cancer imaging with two imaging specialists from Memorial Sloan Kettering Cancer Center, Drs. Anton Becker and Sungmin Woo. Finally, we have a far-reaching interview with Dr. Thomas Newman of University of California San Francisco on clinical epidemiology and his new book Evidence-Based Diagnosis: An Introduction to Clinical Epidemiology. TMPRSS2 and COVID-19: doi.org/10.1001/jama.2020.17386 PSMA PET-CT: doi.org/10.1016/S0140-6736(20)30314-7 Evidence-Based Diagnosis: https://www.cambridge.org/core/books/evidencebased-diagnosis/2807345CA679EC723697ED9C6D98A1AA Back us on Patreon! www.patreon.com/plenarysession Check out our YouTube channel: www.youtube.com/channel/UCUibd0E2kdF9N9e-EmIbUew

Recently, the US released an Emergency Use Authorization (EUA) for the use of convalescent plasma in the treatment of COVID-19. What is an EUA? What does it mean? Is it something the population should be concerned about? Does this mean we should be using it on all patients who are attempting to recover from the virus? Join hosts Shanti and Danny as we discuss the importance of this treatment, whether it holds promise and try to make sense of the political landscape surrounding this treatment.ReferencesLuke, T., et. al.; Meta-analysis: Convalescent Blood Products for Spanish Influenza Pneumonia: A Future H5N1 Treatment?. Annals of Internal Medicine. 17-Oct-2006. 145:8 (599-609). Doi: https://doi.org/10.7326/0003-4819-145-8-200610170-00139 Chippaux, J., et. al.; Production and Use of Snake Antivenin. Handbook of Natural Toxins (Volume 5 Reptile Venoms and Toxins). 03-Mar-1992. 5 (529 - 555). https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.598.1709&rep=rep1&type=pdfNellis, R.; Mayo Finds Convalescent Plasma Safe for Diverse Patients With COVID-19. Mayo Clinic. 18-Jun-2020. https://newsnetwork.mayoclinic.org/discussion/mayo-finds-convalescent-plasma-safe-for-diverse-patients-with-covid-19/VanArsdel, P.; Allergic Reactions to Penicillin. Journal of the American Medical Association. 18-Jan-1965. 191:3 (238 - 239). Doi: https://10.0.3.233/jama.1965.03080030082012Perrone, G., et. al.; Penicillium Species and Their Associated Mycotoxins. Mycotoxigenic Fungi. 07-Dec-2016. (107 - 119) Doi: https://doi.org/10.1007/978-1-4939-6707-0_5Mayo Clinic. Convalescent Plasma Therapy. Patient Care and Health information: Tests and Procedures. https://www.mayoclinic.org/tests-procedures/convalescent-plasma-therapy/about/pac-20486440Siripanthong, B., et. al.; Recognizing COVID-19-Related Myocarditis: The Possible Pathophysiology and Proposed Guideline for Diagnosis and Management. Heart Rhythm Society Cardiac Electrophysiology Society. Sep-2020. 17:9 (1463 - 1471). Doi: https://10.0.3.248/j.hrthm.2020.05.001Ruuskanen, O., et. al.; Viral Pneumonia. The Lancet. 15-Apr-2011. 377:9773 (1264 - 1275). Doi: https://doi.org/10.1016/S0140-6736(10)61459-6

This week, Paola and Taylor both agree about the importance of dogs and hit you with a beachy "Is that an Ism?!" We then move on to examine what in the world quarantine does to us with a study called "The Psychological Impact of Quarantine and How to Reduce it: a Rapid Review of the Evidence." We finish off with a google diaries. Tune in this week to remind yourself you're not alone in the quarantine crazy (we have evidence) and to hear how to stay sane! Our study today is brought to you by Samantha K Brooks, Rebecca K Webster, Louise E Smith, Lisa Woodland, Simon Wessely, Neil Greenberg, and Gideon James Rubin. You can find the study here: https://doi.org/10.1016/S0140-6736(20)30460-8 Please subscribe, rate and review our show on Apple Podcasts! Follow the show on Instagram @studybuddiespodcast Follow Taylor Collins @tlc.therapy Follow Paola Sanchez Abreu @mmm_pao Graphic designed by Monica Rae Summers Gonzalez @_monicarae_ Composed by singer/songwriter Caught In Between @caughtinbetweenct Email the show with any suggestions, comments, or feedback at studybuddiespodcast@gmail.com

We start this week's episode by revisiting our discussion from last week on the PNAS study on racial concordance and birthing mortality. We continue our theme of critical appraisal by then tearing apart the recent paper published in BMJ titled "Two metres or one: what is the evidence for physical distancing in covid-19?" and its inability to support its colorful figures. We end the monologue with a few thoughts on academics who somehow author one paper a week. Finally, we turn to the last two segments of the show: the first is a discussion with Dr. Bishal Gyawali on his new paper out now in The Lancet Haematology titled "A survey in Nepalese patients with acute leukaemia: a starting point for defining financial toxicity of cancer care in low-income and middle-income countries" and the second is Journal Club with a Fellow, where we interview Dr. Justine Ryu on a paper published in The Lancet titled "Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial". Racial Concordance: doi.org/10.1073/pnas.1913405117 COVID-19 Risk: doi.org/10.1136/bmj.m3223 Financial Toxicity: doi.org/10.1016/S2352-3026(20)30258-1 HALT-IT: doi.org/10.1016/S0140-6736(20)30848-5 Back us on Patreon! www.patreon.com/plenarysession Check out our YouTube channel: www.youtube.com/channel/UCUibd0E2kdF9N9e-EmIbUew

With Russia’s announcement and subsequent walking back of their comments on development of a COVID vaccine, the world is left to question how we know a vaccine is ready. The data can be complicated and difficult to find. Join hosts Shanti and Danny as we talk with Dr. Bryan Simons about clinical trials, what they are, how they work, and where we stand with the COVID-19 vaccine currently. ReferencesLowe, D.; In the Pipeline. Science Magazine. Science Translational Medicine. https://blogs.sciencemag.org/pipeline/Description (Phase). U.S. National Library of Medicine. Clinicaltrials.gov. https://www.clinicaltrials.gov/ct2/help/glossary/phaseFatima, K., Syed, N.; Dengvaxia Controversy: Impact on Vaccine Hesitancy. Journal of Global Health. 31-Oct-2018. 8:2. Doi: 10.7189/jogh.08-020312Folegatti, P., et. al.; Safety and Immunogenicity of the ChAdOx1 nCoV-19 Vaccine Against SARS-CoV-2: A Preliminary Report of a Phase 1/2, Single-Blind, Randomised Controlled Trial. The Lancet. 20-Jul-2020. 396:10249 (467 - 478). Doi: https://doi.org/10.1016/S0140-6736(20)31604-4Jackson, L., et. al.; An mRNA Vaccine Against SARS-CoV-2 - Preliminary Report. New England Journal of Medicine. 14-Jul-2020. Doi: https://doi.org/10.1056/NEJMoa2022483Not reviewed as of 23-Aug-2020Keech, C., et. al.; First-in-Human Trial of a SARS CoV 2 Recombinant Spike Protein Nanoparticle Vaccine. MedRxiv. Not Yet Reviewed. Doi: https://doi.org/10.1101/2020.08.05.20168435

On this episode, Dina interviews Dr. Elaine Fitzgerald Lewis, a maternal & child health expert at the Education Development Center. They discuss the benefits of breastfeeding for both individuals and populations as a whole. They cover the challenges to successful breastfeeding as well as program & policy efforts to support those who choose to feed their infants this way. Dr. Fitzgerald Lewis also shares her personal experiences with breastfeeding advocacy. They highlight racial equity as a critical factor. References: 1. Neu J, Sullivan S. Baby and breast: a dynamic interaction. Pediatric Research. 2012;71(2):135-135. doi:10.1038/pr.2011.35 2. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 2016;387(10017):475-490. doi:10.1016/S0140-6736(15)01024-7 3. Anstey EH, Chen J, Elam-Evans LD, Perrine CG. Racial and Geographic Differences in Breastfeeding - United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2017;66(27):723-727. doi:10.15585/mmwr.mm6627a3 4. Office of the Surgeon General (US), Centers for Disease Control and Prevention (US), Office on Women’s Health (US). The Surgeon General’s Call to Action to Support Breastfeeding. Office of the Surgeon General (US); 2011. Accessed August 3, 2020. http://www.ncbi.nlm.nih.gov/books/NBK52682/ 5. Rollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, and what it will take to improve breastfeeding practices? The Lancet. 2016;387(10017):491-504. doi:10.1016/S0140-6736(15)01044-2

It's been 8 months since the first case of the virus formally known as the Novel Coronavirus was found in Wuhan China. That number has grown in 8 months to over 20 Million cases. How do we escape this warped reality that is COVID-19? The answer just might be Operation Warp Speed............sources https://www.cdc.gov/vaccines/basics/test-approve.htmlFact sheet: explaining Operation Warp Speed. US Dept of Health and Human Services. June 2020. Accessed July 30, 2020. https://www.hhs.gov/about/news/2020/06/16/fact-sheet-explaining-operation-warp-speed.htmlO’Callaghan KP, Blatz AM, Offit PA. Developing a SARS-CoV-2 vaccine at warp speed. JAMA. Published online July 6, 2020. doi:10.1001/jama.2020.12190Shah A, Marks PW, Hahn SM. Unwavering Regulatory Safeguards for COVID-19 Vaccines. JAMA. Published online August 07, 2020. doi:10.1001/jama.2020.15725https://www.nccn.org/patients/resources/clinical_trials/phases.aspxhttps://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.htmlhttps://science.sciencemag.org/content/368/6494/945?fbclid=IwAR0BIDm74Kn3bbcX5MP5eLG_zn0kjkP23dSUB0SU-eNY7LKSyaloF7d6L-Ehttps://www.scientificamerican.com/article/how-are-seasonal-flu-vaccines-made/http://www.immunizedelaware.org/for-professionals/vaccine-conspiracies-and-controversies/https://fn.bmj.com/content/76/1/F64.fullhttps://allianceforscience.cornell.edu/blog/2020/04/covid-top-10-current-conspiracy-theories/https://www.climatechangecommunication.org/wp-content/uploads/2020/03/ConspiracyTheoryHandbook.pdfhttps://www.nationalgeographic.com/science/health-and-human-body/human-diseases/coronavirus-vaccine-tracker-how-they-work-latest-developments-cvd/https://www.marketwatch.com/story/fauci-says-public-should-temper-expectations-on-covid-19-vaccine-as-us-infections-near-5-million-2020-08-09https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931605-6https://www.nationalgeographic.com/science/2020/05/moderna-coronavirus-vaccine-how-it-works-cvd/#close

In Episode 10 of Dr. Dave On Call, we discuss with 2 pediatric specialists, Multi-system Inflammatory Syndrome in Children and its association with COVID-19. Multi-system Inflammatory Syndrome in Children (MIS-C) has emerged as a concerning syndrome during the COVID-19 pandemic. Recently, the CDC issued a health care provider alert explaining the background information on several cases of reported MIS-C associated with COVID-19 and also provided a case definition for this syndrome. We discuss MIS-C with Dr. Melissa Tesher, a pediatric rheumatology specialist and Dr. Julia Rosebush, a pediatric infectious disease specialist. Both physicians are Assistant Professors of Pediatric Medicine at the University of Chicago Medicine, Comer Children's Hospital, Chicago, Illinois. Both have treated cases of MIS-C during the past 2 months. The following background of MIS-C will be important to our discussion on how clinicians quickly recognized this association with COVID-19. Toward the end of April 2020, doctors in the UK recognized that previously healthy kids were presenting to pediatric ERs and ICUs with a severe inflammation syndrome that had features of Kawasaki disease-like features. Kawasaki's disease is an illness that was first described by Dr. Tamisaku Kawasaki of Japan in 1967, of an unknown etiology. Kawasaki's disease primarily affects children that are younger the 5-6 years of age. Clinical signs include fever, rash, swelling of the hands and feet, irritation/redness of the eyes, swollen lymph glands and the neck and irritation and inflammation of the mouth, lips and throat. Serious side effects of Kawasaki's disease include inflammation of blood vessels, specifically of the heart that can cause coronary artery dilations and aneurysms. Treatment for Kawasaki's disease is IVIG, aspirin and sometimes systemic steroids.  As UK doctors recognized the increasing cases of healthy children who with severe inflammation with Kawasaki disease-like features, these children also tested positive for COVID-19 active or recent disease. Their symptoms included low blood pressure, multiorgan dysfunction and elevated inflammatory markers, but not one child had respiratory symptoms. The UK described eight cases, one of which died and all tested positive for COVID-19. In early May 2020 in New York City, there were multiple reports of MIS-C in children and as of May 12, there were a reported 102 cases of MIS-C, many of whom tested positive for COVID-19. According to the CDC, the case definition for MIS-C is as follows: Less than 21 years of age, presenting with: a) fever b) lab evidence of inflammation c) clinically severe illness affecting 2 or more major organ systems AND no other plausible cause AND current or recent diagnosis of COVID-19 within 4 weeks of presentation. We know that MIS-C is a rare condition and that pediatric patients who are diagnosed early and treated aggressively do very well. Currently, we are still assessing the association of COVID-19 and MIS-C. This disease may be caused by a post-inflammatory process initiated by COVID-19, and more research will need to be conducted in the future to determine if the association between COVID-19 and MIS-C is strong or weak. Through the guidance of experienced clinicians like Dr. Tesher and Dr. Rosebush, they can provide helpful information to public health entities so that parents can be prepared for particular warning signs of MIS-C, as early diagnosis is paramount. We thank Dr. Tesher and Dr. Rosebush for their immense service to our pediatric patients and helping us navigate an aspect of the COVID-19 pandemic. Citations: https://emergency.cdc.gov/han/2020/han00432.asp (https://emergency.cdc.gov/han/2020/han00432.asp) https://www.cdc.gov/kawasaki/index.html (https://www.cdc.gov/kawasaki/index.html) Verdoni et al. doi: 10.1016/ S0140-6736(20)31129-6  Riphagen et al. doi: 10.1016/S0140-6736(20)31094 More questions, please visit...

This week's topic is all things COVID-19 -- we discuss the viral scandal of British epidemiologist Neil Ferguson's actions and how it reflects (or doesn't) on his work, we talk about the nuances of how to end lockdowns, and we bring back Dr. Benjamin Singer, a pulmonary and critical care physician at Northwestern University, to address updates in the ICU management of COVID-19. Invisible Pandemic: doi.org/10.1016/S0140-6736(20)31035-7 Back us on Patreon! www.patreon.com/plenarysession

We start this episode by diving deep into KEYNOTE-048, the randomized, open-label, phase 3 study of pembrolizumab alone or with chemotherapy v.s. cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (HNSCC). We transition from there to a continued discussion on careerism in academia and how the motivation behind publishing papers should always stem from the drive to disseminate information, not from the drive to advance your own career. We end the episode with an interview with Dr. Bishal Gyawali of Queen's University in Kingston, Canada on his recent paper out in Nature Cancer on global oncology. Specifically, Dr. Gyawali addresses the need for conducting cancer clinical trials in low- and middle-income countries. KEYNOTE-048: doi.org/10.1016/S0140-6736(19)32591-7 Opportunities for Cancer Clinical Trials in LMIC: doi.org/10.1038/s43018-020-0030-x Vinay's new book, Malignant: www.amazon.com/Malignant-Policy-…cer/dp/1421437635 Back us on Patreon! www.patreon.com/plenarysession

In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel sits down with our good friend Dr. Neda Frayha to discuss what we know so far about the new 2019-n-CoV coronavirus outbreak and what front-line clinicians can do if we suspect a patient of ours might have this viral illness.  References: Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMoa2001017.  Munster VJ, Koopmans M, van Doremalen M, et al. A novel coronavirus emerging in China - key questions for impact assessment. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMp2000929 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 24 Jan 2020. https://doi.org/10.1016/ S0140-6736(20)30183-5    Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 24 Jan 2020. https://doi.org/10.1016/S0140-6736(20)30154-9 Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med, 28 Jan 2020. DOI: 10.1056/NEJMc2001272 Wuhan Coronavirus - 2019-n-CoV. Infectious Diseases Society of America. https://www.idsociety.org/public-health/wuhan-coronavirus/. Accessed 29 Jan 2020 2019 Novel Coronavirus (2019-n-CoV), Wuhan, China. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/summary.html. Accessed 29 Jan 2020. Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-n-CoV) in Wuhan, China. Centers for Disease Control and Prevention. https://emergency.cdc.gov/han/han00426.asp. Accessed 29 Jan 2020.   Resource: Centers for Disease Control and Prevention 2019-n-CoV PUI Case Investigation Form: https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdfpdf icon