Podcasts about space orbit

Episode 163: Vascular Dementia      Future Dr. Ruby explains gives a definition of vascular dementia and concisely explains the pathophysiology and presentation of this disease. Dr. Arreaza reminds us of the importance of treating diabetes to prevent dementia.  Written by Carmen Ruby, MSIV, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD. You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is vascular dementia?Vascular dementia is a condition that arises due to damage to blood vessels that reduce or block blood flow to the brain. A stroke can block an artery and result in various symptoms, such as changes in memory, thinking, or movement. Other conditions like high blood pressure or diabetes can also damage blood vessels and lead to memory or thinking problems over time.Vascular dementia (VaD) is a type of dementia that slowly worsens cognitive functions and is thought to be caused by vascular disease within the brain. Patients with VaD often exhibit symptoms similar to Alzheimer's disease (AD) patients. However, the changes in the brain are not due to Alzheimer's disease pathology (amyloid plaques and neurofibrillary tangles) but due to a chronic reduction in blood flow to the brain, eventually leading to dementia. Alzheimer's disease pathophysiology is very complex, and studies have shown that patients with AD can experience simultaneously several vascular issues that can affect cognitive function. For example, patients with AD may experience mini-strokes and have a reduction of the flow of oxygen and nutrients to the brain tissue. So, AD can be worsened by vascular factors as well, but the vascular factors are not the main problem in AD.Clinically, patients with VaD can appear very similar to those with AD, which makes it difficult to distinguish between the two diseases. Nevertheless, some clinical symptoms and brain imaging findings suggest that vascular disease is contributing to, if not entirely explaining, a patient's cognitive impairment.Epidemiology.In the US, VaD is the 2nd most common type of dementia (15-20% of cases). Prevalence increases with age (∼ 1–4% in patients ≥ 65 years.) People affected by vascular dementia typically start experiencing symptoms after age 65, although the risk is significantly higher for people in their 80s and 90s.EtiologyVaD may occur as a result of prolonged and severe cerebral ischemia of any etiology, primarily:Large artery occlusion (usually cortical ischemia) *Acute*Lacunar stroke (small vessel occlusion resulting in subcortical ischemia) *Acute/Subacute**Chronic* subcortical ischemiaRisk factors:Advanced ageHistory of strokeUnderlying conditions associated with cardiovascular disease:Chronic hypertensionDiabetesDyslipidemiaObesitySmokingClinical Features:Symptoms depend on the location of ischemic events and, therefore, vary widely amongst individuals, but a progressive impairment of daily life is common. Because of the diverse clinical picture, the term "vascular cognitive impairment" is gaining popularity over Vascular Dementia.Dementia due to small vessel disease:Symptoms tend to progress gradually or in a stepwise fashion and comparatively slower than in multi-infarct dementia.Generally associated with signs of subcortical pathology:Dementia due to large vessel disease Usually, sudden onsetMulti-infarct dementia: typically, stepwise deterioration Generally associated with signs of cortical pathology:Early symptomsReduced executive functioningLoss of visuospatial abilitiesConfusion ApathyMotor disorders (e.g., gait disturbance, urinary incontinence)Later symptomsImpaired memoryFurther cognitive decline: loss of judgment, disorientationMood disorders (e.g., euphoria, depression)Behavioral changes (e.g., aggressiveness)Advanced stages: further motor deterioration: dysphagia, dysarthriaDementia due to large vessel disease Usually, sudden onsetMulti-infarct dementia: typically, stepwise deterioration Generally associated with signs of cortical pathology:Cognitive impairment in combination with asymmetric or focal deficits (e.g., unilateral visual field defects, hemiparesis, Babinski reflex present)Overall, the symptoms vary depending on which areas of the brain are affected.Management and TreatmentThere is hope when it comes to managing the symptoms of vascular dementia. Although there is no cure for the condition, there are medications available that can help make life easier for those living with it. Additionally, there are drugs commonly used to treat memory issues in Alzheimer's disease that may be effective for individuals with vascular dementia. Sometimes, people with vascular dementia may experience mood changes, such as depression or irritability. These changes can be managed with medications used for depression or anxiety.Vascular risk modification: If your patient is experiencing cognitive impairment and has clinical or radiologic evidence of cerebrovascular pathology, getting screened for vascular risk factors, especially hypertension, is essential. Treatment can help prevent dementia, but it may not be as effective in reversing it. Statins are given after a stroke regardless of lipid levels.Antithrombotic therapy: For patients with vascular dementia who have had a clinical ischemic stroke or transient ischemic attack, they must receive the appropriate antithrombotic therapy based on the specific stroke subtype to help prevent any future ischemic strokes.When considering antiplatelet therapy for patients with vascular dementia who have not had a clinical ischemic stroke or TIA, it is important to make an individualized decision. For instance, we may prescribe aspirin at a dosage of 50-100 mg daily for patients with an infarction seen on brain imaging but not for those with only white matter lesions.Cholinesterase inhibitor therapy: It is recommended to start cholinesterase inhibitor therapy, such as donepezil or galantamine, for patients with vascular dementia who have a gradual cognitive decline that is not a direct result of a stroke. The evidence suggests that this treatment may offer a small cognitive benefit, but the clinical significance is unclear. Experts do not recommend cholinesterase inhibitors for patients with dementia diagnosed after a stroke if there is no gradual cognitive decline.Antipsychotics: We can briefly mention antipsychotics. They may be used but we have to remember they may increase mortality in the elderly, and the patient and family must be aware of this risk. Some examples are risperidone, quetiapine, and olanzapine, use them cautiously. Let's talk beyond medications, what other treatments can we offer? Non-pharmacologic options: In addition to medications, there are various ways to help a person with vascular dementia. Research has shown that physical exercise, sleep hygiene, and maintaining a healthy weight can not only enhance brain health but also reduce the risk of heart problems, stroke, and other diseases that affect blood vessels. Patients must be encouraged to eat a balanced diet, get enough sleep,limit alcohol intake, and encouraged to quit smoking, as these are other crucial ways to promote good brain health and reduce the risk of heart disease. Additionally, comorbid conditions such as diabetes, high blood pressure, or high cholesterol, must be treated, because they affect brain function and quality of life overall.It is essential to understand that emotional outbursts and personality changes can be caused by underlying brain disease and are not always intentional responses or reactions. When behavior problems overwhelm an individual, their family members, or friends, it is critical to seek support. Patient and caregiver support groups are helpful, offering a space to vent, grieve, and gain practical advice from others experiencing similar challenges. Exploring other sources of support, such as adult day programs, can also benefit caregivers and individuals affected by vascular dementia. Conclusion: Now we conclude episode number 163, “Vascular dementia basics.” Future Dr. Ruby explained that vascular dementia is mainly caused by an impaired circulation of blood and oxygen to certain areas in the brain. This can be a result of large or small vessel disease. Dr. Arreaza reminded us of the importance of treating diabetes as a way to prevent dementia. This week we thank Hector Arreaza and Carmen Ruby. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Smith, MD EE, Wright, MD, MS CB. Treatment of Vascular Cognitive Impairment and Dementia. Wilterdink, MD JL, ed. UpToDate. Published online May 24, 2022. Accessed February 27, 2024. https://www.uptodate.comVascular Dementia. Memory and Aging Center. Published 2020. https://memory.ucsf.edu/dementia/vascular-dementiaVascular dementia. AMBOSS. Published online June 29, 2023. Accessed February 28, 2024. https://www.amboss.com/usWhat Happens to the Brain in Alzheimer's Disease? National Institute on Aging, https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/what-happens-brain-alzheimers-disease. Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/. 

Neste papo vamos falar sobre a Starship com Pedro Pallotta, host do Space Orbit e amante dos lançamentos espaciais.

Nesta superlive especial Renan Santos e Ricardo Almeida se juntam a Paulo Cruz e Pedro Palotta do Space Orbit. Discutem sobre o papel da SpaceX na exploração espacial, terraformação em Marte, a produção de foguetes, exploração espacial e muito mais.

Episode 151: Martian Medicine 102Future Dr. Collins discussed with Dr. Arreaza two common complications of astronauts in a hypothetical travel to Mars: Spaceflight-Associated Neuro-ocular Syndrome and mental illness.  Written by Wendy Collins, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Arreaza: We are back for another episode of Martian Medicine! A couple months ago we published the episode Martian Medicine 101. We talked about radiation and its health risks for astronauts going beyond Low Earth Orbit such as a crew going to Mars. Today, we are going to be covering Martian Medicine 102, where we discuss some more risks from the article “Red risks for a journey to the red planet”. So, let's just jump into it! The next risk we are going to talk about is Spaceflight-Associated Neuro-ocular Syndrome or SANS.  Wendy: Yes, so this used to be called Vision Impairment Intracranial Pressure because the syndrome affects astronauts' eyes and vision and can appear like idiopathic intracranial hypertension. But the name changed to SANS because is not associated with the classic symptoms of increased intracranial pressure in idiopathic intracranial hypertension such as severe headaches, transient vision obscurations, double vision, and pulsatile tinnitus. Also, it has never induced vision changes that meet the definiti on of vision impairment, as defined by the National Eye Institute. Its name change also reflects that the syndrome can affect the CNS well beyond the retina and optic nerve. Arreaza: Let's talk about SANS some more. SANS presents with an array of signs including edema of the optic disc and retinal nerve fiber, and what else?Wendy: Edema of chorioretinal folds, globe flattening, and refractive error shifts. Flight duration is thought to play a role in the pathogenesis of SANS, as nearly all cases have been diagnosed during or immediately after long-duration spaceflight such as missions of 30 days duration or longer. But signs have been discovered as early as mission day 10. SANS has been studied in ISS crewmembers who are tested with optical coherence tomography (OCT), retinal imaging, visual acuity, a vision symptom questionnaire, Amsler grid, and ocular ultrasound.Arreaza: About 69% of the US crewmembers on the ISS experience an increase in retinal thickness in at least one eye, indicating the presence of optic disc edema. This can cause an astronaut to experience blind spots and reduced visual function. Fortunately, to date, blind spots are uncommon and have not had an impact on mission performance.Wendy: And chorioretinal folds if severe enough and located near the fovea, an astronaut can experience visual distortions or reduced visual acuity that cannot be corrected with glasses or contact lenses. Fortunately, and despite a prevalence of 15–20% in long-duration crewmembers, chorioretinal folds have not yet impacted astronauts' visual performance during or after a mission.  Arreaza: A change in your glasses prescription is due to a change in the distance between the cornea and the fovea, and it occurs in about 16% of crewmembers during long-duration spaceflight. This risk is reduced by giving crewmembers with several pairs of “Space Anticipation Glasses” (or contact lenses). The crewmember can then select the appropriate lenses to correct visual acuity. Wendy: From a longer-term perspective, SANS presents two main risks to crewmembers: optic disc edema and chorioretinal folds. It is unknown if a multi-year spaceflight like that to Mars will be associated with a higher prevalence, duration, and/or severity of optic disc edema compared to what has been experienced onboard the ISS. Since the retina and optic nerve are part of the CNS, if optic disc edema is severe enough, the crewmember risks a permanent loss of optic nerve and retinal nerve fiber tissue and thus, a permanent loss of visual function. But again, no astronaut has experienced SANS-related permanent vision loss and choroidal folds usually improved post-flight in affected crewmembers. Arreaza: It is important to understand the pathogenesis of SANS. In microgravity, fluid can distribute uniformly. The fluid that normally pools in your legs due to gravity can now move to your head and cause congestion of the cerebral veins. The pathophysiology of SANS is that CSF outflow can be blocked, which increases intracranial pressure. Wendy: There can be confounding variables such as exercise, high-sodium dietary intake, and high carbon dioxide levels. It is difficult to know much about SANS because there are not many crewmembers who have completed long-duration spaceflight. There is now enough evidence to state that SANS is not a male-only syndrome. Optical Coherence Tomography (OCT) has been used on the ISS since 2013, and it has allowed NASA to build a database of retinal and optic nerve images to understand SANS better. Research from this has shown that most long-duration astronauts present with some level of optic disc edema.Arreaza: Now all NASA crewmembers receive pre- and post-flight MRIs of the brain. There is evidence that brain changes structure with longer space flights. For example, the ventricles of the brain enlarge with 2–3 mL of CSF in astronauts. Luckily, there has been no cognitive problems with this. Like with most space health concerns, more research is needed. Wendy: In summary, SANS is a red risk and top priority to NASA and the human research program. The main concern with SANS is optic disc edema because it could lead to permanent vision impairment. And choroidal folds are also concerning for both short- and long-term flights. But for now, loss of visual acuity is successfully combatted with glasses. Certainly, the more astronauts and flights we take, the more we will learn about SANS.Wendy: Sorry we took so long on SANS, it's probably one of my favorites of all the red risk. Now let's move onto the red risk that includes behavioral health and performance. Future long duration mission in which you are in an isolated and confined space such as a space craft surrounded by an inhospitable environment which humans are not meant to survive could be a problem for the crew's behavioral and mental health. Arreaza: This could affect the astronauts and their ability to complete their mission. Typically, astronauts enjoy space and report it is a positive experience. But psychological changes from being in space for a long time will likely be even more challenging. Wendy: In the past, astronauts have reported ‘hostile' and ‘irritable' crew and symptoms of depression. Arreaza: Stressors to the ISS include long work hours and high workload, and the discomfort of space motion sickness. No one likes vomiting.  Wendy: Being on the ISS, you are close to Earth, and it is easy to communicate with family and friends when needed. Going to Mars there will be communication delay and will make support more difficult. Astronauts on the ISS also have routinely received care packages, which will also not be available to boost morale. Crew members can also change by swapping out astronauts over a certain period, but the crew to Mars will also not have this ability to work with new people.  Arreaza: There are simulation projects to test human resilience. NASA does these kinds of testing at the Johnson Space Center. There is also research in Antarctica that has shown decreased mood and increased stress for scientists in extreme environments. There is also the Mars 500 mission.  Wendy: Yes, the Mars 500 mission was where a crew of 6 went into isolation in Moscow for 520 days to simulate a trip to Mars. The astronauts had to complete behavioral questionnaires weekly. One of the six reported depressive symptoms based on the Beck Depression Inventory. Two crew members who had the highest ratings of stress and exhaustion, also reported conflicts and sleep difficulties. Two crew members reported no adverse behavioral symptoms during the mission.Wendy: So, I believe we're done. We've covered Radiation, SANS, and behavioral health. I know this topic is probably unique for qWeek, but a lot of what we learn medically from our time in space does have applications to us on Earth. As a medical student advice, I have gotten from others in the field is pursue what you're passionate about. Aerospace medicine is a growing field for clinicians from all specialties, so there's no golden path to take. If you are interested more in this field, I highly recommend joining relevant associations specifically AsMA and AMRSO. And if you ever want to discuss aerospace medicine further, feel free to reach out to me at my Ross email!______________________Conclusion: Now we conclude episode number 151, “Martian Medicine 102.” Future Dr. Collins explained that ocular issues are a potential problem when astronauts go to Mars, including Spaceflight-Associated Neuro-ocular Syndrome and vision impairments that would require changes in glass prescription, so, don't forget to take extra pairs of glasses when you go to the red planet. Dr. Arreaza also joined the conversation by talking about the mental health challenges that many astronauts may face as they embark on a long trip to Mars in a secluded spacecraft. We look forward to more information on Martian Medicine as primary care on Mars may look surprisingly similar to primary care on Earth.This week we thank Hector Arreaza and Wendy Collins. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Patel, Z.S., Brunstetter, T.J., Tarver, W.J. et al. Red risks for a journey to the red planet: The highest priority human health risks for a mission to Mars. npj Microgravity 6, 33 (2020). https://doi.org/10.1038/s41526-020-00124-6Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022, from https://freemusicarchive.org/music/Scott_Holmes/. 

O planeta Terra não é o bastante, então nossos hosts Gustavo Rebello (@gu_rebel) e JP Miguel (@jp_miguel) decidiram essa semana ir até a Lua com o Pedro Palotta (@Pallottapedro) do canal Space Orbit para entender essa corrida pelos recursos naturais do satélite. Entenda o papel dos Estados Unidos, China, India e Rússia nessa disputa, quais leis e tratados se aplicam, e quem anda espionando quem! Demais destaques ficam por conta do Canadá. TUDO ISSO além da agenda da semana e das dicas culturais! Lembrando sempre que mandem sugestões, críticas, para contato@opodnext.com, ou ainda no SUBSTACK: opodnext.substack.com onde você também encontra informações sobre como assinar o Podnext Confidencial, para nos apoiar e ter acesso ao conteúdo extra que ficou de fora do programa, chat exclusivo do Telegram, assista gravações AO VIVO e muito mais! LEMBRANDO QUE agora o PODNEXT TEM ZAP, anote aí o número, +1 352-871-5797 pra vc mandar mensagem de voz e talvez aparecer no programa! Se você desejar, pode contribuir quando e se puder também fazendo um PIX para contato@opodnext.com E BORA PRO PROGRAMA! --- Send in a voice message: https://podcasters.spotify.com/pod/show/podnext-podcast/message Support this podcast: https://podcasters.spotify.com/pod/show/podnext-podcast/support

Episode 147: Routine Prenatal CareWritten by Elika Salimi, MSIV. Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments and editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice._____________________Elika: So, we're going to talk about some general principles of prenatal care and some of the most important diagnostic methods that we mainly use for taking care of pregnant women. I will forewarn you that there will be a ton of details in this talk, and I do recommend possibly taking notes as things can get easily confusing. This way you can have something to refer back to whenever you have a pregnant patient of your own.Arreaza: You can also download the episode notes from our website.Elika - So your patient is pregnant and she comes to you for care. How do we go about it? Well, this is assuming she had it at home urine pregnancy positive test and we got a blood hCG on her and everything's good and we know she's pregnant. Ok so now what happens next?Arreaza – We need to confirm the patient wants to keep the pregnancy.Elika - First, we're going to talk about the frequency of the check-ups. In this case, we are talking about a situation where the mother is coming to her appointments as she was supposed to but we all know that sometimes that doesn't happen if everything is going as it is supposed to then typically we get the initial examination at about 10 weeks of gestation and then until the 28th week there should be monthly visits, then from the 28th through the 36th there should be biweekly visits, and from the 36th week until birth, the visits are every week.Areaza – What´s next?Elika - Now I'd like to note that during the prenatal period, informed consent is very important and it should be obtained during this time because you want to prevent and manage any ethical conflicts that might exist between the mother and possibly the healthcare providers because we all know that any pregnancy can become high-risk at some point and pregnant individuals should be informed about the potential need for a c-section for example and be encouraged to discuss any concerns ahead of time. Elika - Now while we're talking about ethics, if the doctor finds him/ or herself in a situation where the patient is asking for something that the Dr does not feel comfortable with such as a certain type of treatment or a certain method of delivery or if they're, let's say, desiring an abortion and the doctor doesn't do abortions, then in this case you would refer the patient to a physician that is comfortable with the patient's desired outcome or treatment. And this is perfectly legal and fine just as long as you help the patient find somebody else. Arreaza – Abortion is legal in most states, but check your local regulations.Elika - So as mentioned earlier, the initial visit occurs at about 10 weeks of gestation. We start with checking their personal and family history and finding out about any previous pregnancies including at what GA baby born and weight if they know, any complications, gestational diabetes or preeclampsia, any history of postpartum hemorrhage requiring blood transfusion, any abortions (if present at what GA), and the method of deliveries, whether it was vaginal or a cesarean and what kind of C-section they had done. These are very important for you to obtain from your patient. You will also assess for depression and domestic partner violence.Arreaza – In California, we have a wonderful service called CPSP: Comprehensive Perinatal Services Program. What comes next? Elika - Upon receiving the history, we will do the gynecological examination and send in some samples. We will also send her to do some lab work. Now what do those labs entail? Well, we are going to get a CBC such as screening for anemia, we will also do TSH but only in people who have possible signs of thyroid disorder so not everybody needs to get this. And, we are going to send for a blood typing to find out about their ABO group and the Rhesus status. We will also obtain a urine analysis to screen for proteinuria and asymptomatic bacteriuria because in pregnancy, unlike outside of pregnancy, you do need to treat asymptomatic bacteriuria. We will also ensure that the mother is on prenatal vitamins, so folic acid, if not already, and iron, if indicated, and vitamin B6 if the patient has signs of nausea or hyperemesis gravidarum and this can be combined with doxylamine. Usually, pregnant women don't get a glucose screening test at the first visit unless let's say they have high risk of diabetes or they there was glucose in the urine. Arreaza – I like the topic of diabetes in pregnancy. So, in a high-risk population, we want to make sure a pregnant patient does not have diabetes, or pregestational diabetes.Elika - We will also screen for STI's including HIV, syphilis, hepatitis B, Hep C, and we also check for gonorrhea and chlamydia (pap) screening particularly in those under 25, or over 25 with high risk of infection. We will also test for rubella and varicella. Some places also order a QuantiFERON gold for tuberculosis. There are certain women that have indications for third-trimester screening for STI's on top of the ones that they already got in their first trimester. Those include chlamydia, gonorrhea, HIV, syphilis, and Hep B, and C but each of those have its own indications so for the purposes of time I will let you look that up on your own.Arreaza – Summary: Physical exam and labs to rule out preexisting conditions that may interfere with pregnancy, either infectious or metabolic, to mention some diseases. Elika - And finally, we will do an ultrasound assessment to get a more accurate reading of the fetus's gestational age.Arreaza – What comes after the first trimester?Elika- So like I mentioned they're going to need to be following up and some particular things need to be done at specific weeks. So we are going to discuss those. At every follow visit you need to obtain: the patient's weight, BP and other vitals, fetal heart sounds, the baby's measurement from the mother's pubic symphysis up until the fundus of the uterus, as well as a urine analysis to check for any glucose or protein in the urine because we are always concerned of possible preeclampsia or gestational diabetes. Another examination that I should mention is a Doppler ultrasound and this is usually indicated if there is suspected fetal growth restriction or if there's pregnancy-induced hypertension or if there's suspected fetal deformities or there is growth discordance in multiple pregnancies.Now we are going to discuss assessing for any abnormalities in the fetus. All pregnant women regardless of age should be offered noninvasive and aneuploidy screening test before 20 weeks of gestation. The 1st trimester combined screening occurs at about 10 to 13 weeks gestation, where we can order some blood tests for the mom such as the amount of hCG in maternal serum, as well as PAPP-A, on top of nuchal translucency that will see on the ultrasound. There is also the triple screen at 15-20 weeks which consists of ordering hCG, alpha-fetoprotein aka AFP, and estriol then there's also the quad screen test at 15-22 weeks gestation that consists of hCG, AFP, Estriol and Inhibin A. We also have the cell free fetal DNA testing that can occur after 10 weeks gestation at which the fetal DNA is isolated from the maternal blood specimen for genetic testing and this one actually happens to be the most sensitive and specific screening test for common fetal aneuploidies, and it is used for secondary screening after the ultrasound.Arreaza – Actually that test is done in all our patients on Medi-Call (cfDNA).Elika - If any of the screening tests are abnormal then we can provide counseling to mothers for more invasive diagnostic tests such as chorionic villus sampling, amniocentesis, and cordocentesis. At that point, you want to refer the patient to perinatology. Finally, in general an anatomical scan occurs ~18-22 weeks. Arreaza – Excellent, we have done the non-invasive genetic screening. What's next? Elika - Now we are going to talk about what happens in the third trimester specifically and what test you need to order. In the third trimester, you will order a CBC again, particularly at 24 weeks you want to do a repeat hemoglobin. We will also do the indicated repeat STI checks. We are also going to do gestational diabetes screening with the oral glucose test that I briefly mentioned earlier at around 24-28 weeks. This is usually done with a 50g 1 hr glucose tolerance test and if abnormal then a 100g 3 hour glucose test. You will also be repeating the Rh antibody just to make sure that the mother is still Rh negative because at 28 weeks, Rh negative mother should be administered RhoGAM 300 mcg intramuscularly and they need to get it again within 72 hours of delivery. Don't forget to give a TDAP vaccine at 27 weeks. And at 36 weeks you need to be obtaining a GBS culture (vaginal and rectal) for the patient just to make sure that there is no colonization because if there is then the patient is going to need GBS prophylaxis at admission because colonization by these bacteria can cause chorioamnionitis and neonatal infection such a sepsis. Overall when third trimester approaches you're going to make sure the plans for delivery have been properly scheduled or discussed with the patient and typically around 34 weeks you also want to check with your patient to see if they desire sterilization and obtain a consent if they will be having a C-section and they want to be sterilized after that. In those not requesting sterilization, it is a good idea to discuss what they want to do after this pregnancy for birth control since it is not safe to get pregnant again for another year. From 36 weeks' gestation, use Leopold maneuvers for assessment of fetal presentation but I'll let you look that up on your own. At this time, you may also use ultrasound as needed to confirm fetal lie and placental position.Patients with maternal conditions such as gestational diabetes or gestational hypertension/pre-eclampsia, or fetal condition such as heart defects or fetal growth restriction need to get biweekly NST/BPP tests at clinic in the third trimester because there is an increased risk of fetal hypoxic injury or death. An NST is basically a non-stress test that measures fetal heart rate reactivity to fetal movements. BPP /biophysical profile is a noninvasive test that evaluates the risk of antenatal fetal death usually after the 28th gestational week and what it consists of is the ultrasound assessment of fetal movement, fetal tone, fetal breathing, and amniotic fluid volume or we can also perform a contractions stress test that basically measures fetal heart rate reactivity in response to uterine contractions. Arreaza – I like talking about obesity. Weight gain is expected during pregnancy. Patients with normal weight are expected to gain 25-35 pounds. Patients with obesity are recommended to gain 11-20 only.Summary: Now I know that this was very extensive talk with a ton of details but if you took notes and refer back to it then I think things will somewhat make more sense and come together that way. The best thing we can do is try to adhere to guidelines to make sure that we don't miss anything. Sometimes it could be particularly difficult to manage patients that don't or can't come to their appointments regularly and you may sometimes have to give them bad news and what not so overall it is not always happy moments we face but the best we can do is try to give them the best care possible to avoid complications and have the patient deliver a healthy baby. Thank you for listening to me once again and hopefully I'll be back again soon on another talk on an OB/GYN related topic soon. Thank you very much. _____________________Conclusion: Now we conclude episode number 147, “Routine Prenatal Care.” Future Dr. Salimi gave an excellent summary of the care provided during the different trimesters of pregnancy. Remember to collect a detailed history, perform a comprehensive physical exam, and order the labs to rule out pre-existing conditions that could interfere with pregnancy or detect complications early to start timely interventions or refer to a higher level of care. This week we thank Hector Arreaza, Elika Salimi, and Verna Marquez. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:AAP, ACOG. Guidelines for Perinatal Care. American College of Obstetricians and Gynecologists Women's Health Care Physicians; 2017Zolotor AJ, Carlough MC. Update on prenatal care. Am Fam Physician. 2014; 89(3): p.199-208. pmid: 24506122.World Health Organization. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. World Health Organization; 2016Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70(4): p.1-187. doi: 10.15585/mmwr.rr7004a1Murray ML, Huelsmann G, Koperski N. Essentials of Fetal and Uterine Monitoring. Springer Publishing Company; 2018Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.

SÉRGIO SACANI e PEDRO PALLOTTA são amantes do vasto vazio chamado espaço sideral. Sacani tem o canal SPACE TODAY, com fatos e curiosidades sobre tecnologia espacial e o Universo, e Pedro é dono do SPACE ORBIT, um canal mais voltado para o lançamento de foguetes e história dos programas espaciais. Já o Vilela está até hoje tentando manter contato com seu planeta natal.

Episode 134: Martian Medicine 101.    Future doctor Collins and Dr. Arreaza talk about the health risks of going to space and to Mars, especially the effect of radiation. Written by Wendy Collins, MSIII, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Today is March 31, 2023.Arreaza: Wendy, I confess I am excited for today's topic. My love for space began with E.T. (I know, I am old). I was exposed to that famous movie when I was a little kid, and ever since, I have had a tremendous curiosity about space and Mars. Honestly, I did not think this could be a topic for our podcast until I met you. Wendy: I got inspired to talk about space medicine because I want to go into this field. My college degree was in Physics, and I was fortunate to do Astrophysics and Particle Physics research as an undergraduate, as well as coral reef research. I am passionate about Medicine and treating patients, but I also love Aerospace Medicine because it's so interdisciplinary. Flight surgeons get to scuba dive, work on oceanography, botany, engineering projects, and more, and collaborations like that sound exciting to me. Anyways let us talk about what is going on in the industry right now. Dr. Arreaza, do you know what humans are doing in space this year?Arreaza: I do! I like to watch the launches online and in person. I have seen several SpaceX rockets from my backyard (something I never imagined I could do), and there has been some big news, we are going back to the moon! Wendy: Yes! Artemis 1 was a successful unmanned mission to orbit the moon and it was launched in November and landed in December last year. Now we look to Artemis 2, which will be a manned lunar flyby. So, like Artemis 1, but with astronauts onboard. And the goal for future missions after that is to land on the moon, establish a lunar base, and eventually prepare us for a long-term space flight like that to Mars. And there is even a presidential order to land humans on Mars by 2033. Arreaza: Yes, it is very exciting! BUT there are many, many human health risks to space flight.Wendy: Even more for space flight outside of low earth orbit. Because of this, and because space flight is becoming commercialized, space medicine is a growing field, and growing in all medical specialties. Believe it or not, I was just in a talk by a NASA flight surgeon where it was mentioned that NASA is even looking for OB/GYN because 50% of their astronauts are women who need gynecological care, and they currently have to go off-site to receive it.Arreaza: That's so cool! I've read of a handful of civilian and military aerospace medicine training programs for physicians after residency. And since we're in Bakersfield and only a stone's throw away from this campus, why don't we briefly mention the University of California Los Angeles?Wendy: Yes, so UCLA established an aerospace fellowship very recently in 2021. That fellowship, unlike the rest of them, is actually for board-certified emergency medicine physicians only right now, I believe the only one that does not consider other specialties like internal medicine and family medicine, but the program is new so who knows that may change. The fellowship's goal is to train the next generation of space flight surgeons. Part of the medical training includes working in arctic environments, Mars analog missions, which includes rotations at SpaceX and NASA's jet propulsion laboratory. There are so many new avenues to pursue education and jobs in aerospace medicine but today we're focusing on some research that's near and dear, and revolves around how we get to Mars in one piece. You may ask, what are the health risks of going to Mars? Ultimately, I would like to chat about how we mitigate those risks, but first let's define them.Arreaza: So, we got some ideas from a paper published in 2020 by Patel et al. It is titled: Red risks for a journey to the red planet: The highest priority human health risks for a mission to Mars. Let's begin.Wendy: Spaceflight is dangerous with unique risks and challenges. As a space flight surgeon, your job revolves around ensuring the overall safety of the crew, as well as their physical and mental health and well-being. The major health hazards include radiation, altered gravity fields, and long periods of isolation and confinement. Each of these threats is associated with its own set of physiological and performance risks to the crew.Arreaza: But crews do not experience stressors independently, so it is important to also consider their combined impact. NASA's Human Research Program researches over 30 categories of health risks astronauts can face with space flight.Wendy: Yes, but this article only discusses 4 of those categories, but don't worry, they are the biggies, they are the “Red Risks.”Arreaza: So, what are Red Risks?Wendy: Red Risks are risks that are considered the highest priority due to their greatest likelihood of happening and because they are most detrimental to the crew's health and performance, which impacts the success of the mission.Arreaza: There also exists “yellow” and “green” risks too, which of course are important, but less severe or less likely to occur than the Red Risks. Wendy: I just want to say I really like the title of this paper. Red risks for a journey to a red planet because Mars of course is red. Anyways as part of this paper, the “red risks” we are going to cover are space radiation health risks. This paper also covers spaceflight-Associated Neuro-ocular Syndrome, which is also known as SANS, behavioral health and performance, and inadequate food and nutrition. But today, we are only going to cover radiation health risks. But one thing this article did not discuss was the human health risk of infection, so let's briefly mention it now. Arreaza: Yes, I can imagine spacecrafts are not sterile environments. It would be important to mitigate infections and hygiene necessities and have antibiotics that are functional and not expired or altered by radiation. Alright let's start with the first health risk on the list, radiation.Wendy: Space radiation health risk is a large topic because it does not just predispose you to cancer, it also affects many organ systems. So, we are going to break down the health risks caused by space radiation exposure into of course radiation carcinogenesis, but also cardiovascular disease, degenerative tissue effects, and lastly acute in-flight as well as late central nervous system effects. Arreaza:Wendy: Yes the spacecraft does filter some radiation of course, but not Earth's atmosphere. It's actually a common misconception that astronauts on the International Space Station are protected by Earth's atmosphere. But it's not the atmosphere, it's Earth's magnetosphere, which is protective from radiation on some level because it absorbs many high-energy protons from space that, if not absorbed, would interact and cause damage to whatever is around. Arreaza: But astronauts on the ISS are exposed to radiation, how much?Wendy: So, about one weekon the ISS is approximately equivalent to one year's exposure to radiation on the ground. But astronauts going to Mars are going to be in space a lot longer than one week. NASA's 2020 Perseverance rover mission took 7 months to get to Mars.Arreaza: And that's without Earth's magnetosphere, and not considering any travel back home. That's a lot of radiation. How much radiation exposure would you get traveling to Mars?Wendy: The crew to Mars would be exposed to pervasive, low dose-rate galactic cosmic rays, and to intermittent solar particle events. Arreaza: Wow galactic cosmic rays?Wendy: Yeah, they sound cool but they're not the ones that give us superpowers like in the Fantastic Four. It means high charge and high energy protons will come into contact with the spacecraft and all the things inside. While the spacecraft will act as a shield, it will never be an entirely perfect shield and protons will penetrate and interact with human tissues, and you know what that means Dr. Arreaza…Arreaza: DNA breaks which can cause diseases including cancer, cardiovascular and neurologic disorders. Wendy: Exactly. It's important to note there are so many variables including the spacecraft design, what's happening with the sun, and the duration of the trip. And because of all these things, the risk assessment for radiation exposure is difficult to pinpoint because it's truly going somewhere we've never gone before. The types of radiation encountered in space are very different from the types of radiation exposure we are familiar with here on Earth. There have been radiobiology experiments working on simulating space radiation here on Earth, but we still lack reliable human data.Arreaza: Interestingly, the astronaut with the longest space flight, a Russian physician astronaut Dr. Valeri Polyakov, was on the ISS for 437 days. Dr. Polyakov recently passed away. His cause of death is not disclosed, but he lived a long life into his 80s, so at least we know he did not get terminal cancer after all that time in space.Wendy: Yes, and that was just Dr. Polyakov's longest flight. He was on five different Soyuz missions and 2 MIR missions. So, there will be radiation no matter what, what can be done about it?Arreaza: There's ongoing research focused on age, sex, and health of the astronaut. Not all people are affected by radiation the same way. Biomarkers are being investigated to determine who will be less sensitive to radiation.Wendy: Exactly just like we have biomarkers to know if you are predisposed to developing cancers. But back to space.The major cancers of concern from space radiation are epithelial in origin, particularly lung, breast, stomach, colon, and bladder, and leukemias. Radiation is a “red risk” also because of the likelihood of developing cancer after the mission back on Earth. Dr. Polyakov was fortunate to live a long life, but what about our Mars astronauts with even greater radiation exposure?Arreaza: This research paper even mentions cancer is a long-term health risk and although it is rated as “red”, most research in this area is currently delayed. This is because NASA's Human Research Program is focusing on in-mission risks, not the risks after the mission. But research is still being done to establish radiation dose thresholds, specifically permissible exposure limits. Wendy: So now let us talk about the effects of radiation that is not cancer.Arreaza: So, we know radiation can cause many other health problems. This includes cardiovascular and cerebrovascular diseases, cataracts, digestive and endocrine disorders, immune deficiencies, and respiratory dysfunction. Wendy: Specifically, we know cancer patients who have received high-dose radiation to the mediastinum, are at an increased risk for cardiovascular disease including heart attack and stroke. An astronaut who goes to Mars is more likely to die from a heart or vascular disease secondary to radiation than cancer.Arreaza: NASA also is concerned about the effects of other inflight risks such as more blood flow to your head without the effect of gravity. Not to mention developing atherosclerosis, myocardial infarction, stroke, or arrhythmia just like anybody else on Earth.Wendy: There is also chronic inflammation and increased oxidative stress from radiation, which contributes to cardiovascular disease. For example, the mechanism of increased endothelial dysfunction.Arreaza: Health problems are not only a result of spaceflight but there can be pre-existing conditions. Astronauts are extensively screened medically, but diseases can also arise in astronauts who are “healthy” before leaving. Wendy: Absolutely, which is why right now only extremely healthy individuals are candidates to become astronauts, although this will likely change as space becomes more accessible the more spaceflight commercializes.Arreaza: Other diseases induced by radiation include CNS effects. Acute CNS problems that may arise during flight are impaired cognitive function, motor function, and behavioral changes. These would cause serious problems for astronauts.Wendy: Besides acute, there are also chronic CNS problems. This includes Alzheimer's disease, dementia, or accelerated aging. This has been shown with rodents exposed to radiation in which neurons and neural circuits change causing performance deficits.Arreaza: It is important to note that no astronauts have suffered from life-changing radiation damage illnesses to date.Wendy: Again, back to Dr. Polyakov is evidence of that. And again, more research needs to be done to understand the significance of radiation to human health and determine how much radiation is too much radiation.Arreaza: That was Martian Medicine 101. Why are we talking about space medicine in this podcast?Wendy: Space medicine might be an out-there topic for our Family Medicine podcast. But going into space has given us technologies that help us in our day-to-day in life for non-medical folks, but also for primary care staff. The aural thermometer that takes your temperature by being placed near your ear was developed by NASA. Also, ventricular assist devices LASIK, cochlear implants, and artificial limbs scratch-resistant lenses for glasses, are all works that have contributions from NASA. Anyways, radiation was a fun topic today, but stay tuned for Martian Medicine 102, coming soon when we will talk about the other health risks of going to Mars.____________________Conclusion: Now we conclude episode number 134 “Martian Medicine 101.” As you can see, family medicine is unlimited, in the future you may be working on Mars as a family doctor. An inquisitive future doctor, Wendy Collins, explained that radiation is one of the major risks of long space flights because besides cancer, radiation may also cause cardiovascular diseases, immune deficiencies, and respiratory problems. Dr. Arreaza reminded us that radiation does not affect everyone the same way and even though astronauts are screened extensively, at this point it is difficult to determine with precision who will be a perfect fit for space flights. Stay tuned for Martian Medicine 102.This week we thank Hector Arreaza and Wendy Collins. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:Patel, Z.S., Brunstetter, T.J., Tarver, W.J. et al. Red risks for a journey to the red planet: The highest priority human health risks for a mission to Mars. npj Microgravity 6, 33 (2020). https://doi.org/10.1038/s41526-020-00124-6Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/. 

Everyone knows the famous horns of Strauss's Also sprach Zarathustra thanks, primarily, to its presence in Stanley Kubrick's 2001: A Space Odyssey. When used, the viewer is witnessing the advancement of technology -- from bone tools to satellites seemingly floating above the big blue ball called Earth. But Kubrick's vision of the future wasn't unfounded. The ships, floating effortlessly and motionless above Earth, are simply in orbit -- a physics principle that kept the astronauts of Apollo 8 from crashing into the moon, keeps the moon from crashing into the Earth,  and keeps Earth from crashing into the Sun. But how? That's what we dive into today!Topics IncludeIt's fall, y'all!Third consecutive episode mentioning Rings of PowerBone tools, the invention of beat-downs, and imagery of satellitesOrbits: just falling too fast (or not fast enough, depending on your perspective)Cannonballs and thought experimentsWill's soon-to-be famous geography tiradeShutter Shades, LMFAO, and privacy screens for your computerWant to contact us? You can!@podcastframesreferenceframespodcast@gmail.com

Episode 109: Shingles vaccine before 50 Prabhjot and Dr. Arreaza discuss the indications and contraindications of the zoster recombinant vaccine (Shingrix®). Shingrix is now FDA-approved to be used in people younger than 50 years old. Magic mushroom as a therapy for alcohol use disorder. Introduction: “Magic mushroom” as a potential treatment for alcohol addiction By Hector Arreaza, MD. Addiction is one of the biggest challenges in medicine. Patients with addictions are at risk of adverse events or even death from overdose but also are at risk of withdrawal when trying to quit. As medical providers, our goal is to assist our patients to stop using substances that may be toxic and cause detrimental effects on their health in the short and long term. It is not easy to help patients overcome the discomfort, cravings, and even life-threatening symptoms that result from withdrawal. Out of the many addictions, alcohol use disorder is one of the most destructive addictions, and the harms from it go beyond the personal effects, as it affects families, communities, and the whole nation. It is a serious public health issue. It is estimated that 15 million people (12 and older) in the US have alcohol use disorder, and about 140,000 people die every year from alcohol-related causes. Many patients would like to stop drinking, but the withdrawal symptoms may be more than just discomfort and may become unbearable and even fatal. Today I want to share the news published on August 24, 2022, on JAMA and many news outlets regarding the potential use of Psylocibin as an adjunct therapy to quit drinking alcohol. This was a double-blind randomized clinical trial that compared Psylocibin with diphenhydramine. Psilocybin is also known as “magic mushroom”. Participants were offered 12 weeks of psychotherapy and were randomly assigned to receive psilocybin vs. diphenhydramine during 2-day-long medication sessions at weeks 4 and 8. There were 93 participants. The percentage of heavy drinking days during a 32-week period after the first dose of medication was 9.7% for the psilocybin group and 23.6% for the diphenhydramine group. So, patients in the Psylocibin group had decreased heavy drinking, and the mean alcohol consumption was also lower. Blinding was an issue during the study because many participants could guess which medication they were receiving. Some participants described “flying over landscapes, seeing [their] late father and merging telepathically with historical figures.” The bottom line of the study is that administration of Psilocybin in combination with psychotherapy produced a significant reduction in the percentage of heavy drinking days over and above those produced by active placebo and psychotherapy. These are exciting news for those who are trying to quit alcohol, and it provides a foundation for additional research on psilocybin-assisted treatment for AUD. This is the Rio Bravo qWeek Podcast, 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. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice. ________________________________________________________________________________________________________________ Shingrix before 50. By Prabhjot Kaur, MS4, Ross University School of Medicine. 1. What is Shingrix? It's a recombinant zoster vaccine to protect against Herpes Zoster (Shingles) in adults over 50 years old. 2. What is Herpes Zoster? Prabhjot: It's a viral infection that is caused by the Varicella-Zoster virus, which also causes chickenpox. Chickenpox, also called varicella, can happen in children and adults. After a person is infected with chickenpox, the virus remains dormant in the dorsal root ganglia, which are the clusters of neurons along the spinal column. As the person grows older, or his or her immunity decreases due to conditions such as an infection, malignancy, or pregnancy, the dormant virus becomes reactivated. Prabhjot: When the virus reactivates in adults, it presents with a painful, blistering, itchy rash over the specific dermatomes. The rash mostly occurs on the torso, face, or upper extremities, and it is usually only on one side of the body. Arreaza: A common belief in the Latino culture (since our audience sees a lot of patients of Latino descent) is that if the rash crosses the midline of your body and it makes a circle around your chest, you will die. If you, as a doctor, get that question from a patient, the answer is: herpes zoster normally affects the root ganglia on one side of the body. If your patient has bilateral herpes zoster, you must rule out immunodeficiency. The rash may be preceded or followed by pain, burning, numbing, or tingling of the skin. Some patients might even have fevers, chills, fatigue, and photosensitivity. One of the most common complications of shingles is postherpetic neuralgia, which is a long-lasting pain after the blisters and rash have resolved. 3. What is the role of the vaccine? Prabhjot: Shingrix® can reduce the risk of shingles and its complications, such as postherpetic neuralgia. Shingrix is recommended for everyone over 50, even if they have already had shingles, received Zostavax® (discontinued in 2019), or received the varicella vaccine. Arreaza: Good point. Let´s talk a little bit about varicella in adults. Patients who have received the varicella vaccine as a child can still receive Shingrix. Let's remember the chickenpox vaccine (varicella vaccine) became available in the United States in 1995. Normally, a serology test for varicella is not required for people to receive the varicella vaccine as adults, except in certain patients who are planning immunosuppression in the near future. In such cases, if varicella immunity is not reactive, they should be vaccinated against varicella (live attenuated virus) if the immunosuppression can be delayed. Prabhjot: What if the patient is already immunosuppressed? Arreaza: If the patient is already immunosuppressed, the decision is not simple. The varicella vaccine is contraindicated, but some clinicians may recommend Shingrix for the potential protection against primary varicella. Post-exposure prophylaxis with antiviral therapy or immunoglobulin in case of exposure is possible. 4. How is Shingrix given? Prabhjot: Shingrix is given in 2 doses, and each dose is given 2-6 months apart. Its immunity stays strong for at least 7 years. Like most vaccines, the most common side effects of the Shingrix vaccine are redness, tenderness, swelling, and discomfort at the vaccine site. Shingrix is deemed to be safe for most people over 50 but not given to pregnant women, people with active shingles, and or with a severe allergy to the vaccine. Arreaza: Shingrix is generally avoided in patients with a known history of Guillain-Barré syndrome (GBS) due to a probable association between Shingrix and GBS. This association was not seen with Zostavax, so in case of history of GBS, Zostavax is an option. 5. Effectiveness. Prabhjot: As for its effectiveness, according to the CDC, Shingrix is 97% effective in preventing shingles in adults 50 to 69 and 91% in adults older than 70. If one is immunosuppressed and has a weakened immune system, the vaccine was effective, ranging between 69%-91% in preventing shingles. 6. New update: Prabhjot: New updates have been made to expand the vaccination of the population under 50 as well. On July 23, 2021, the FDA approved the vaccination for adults over the age of 18 who are at an increased risk or will be in the future due to immunodeficiency or immunosuppression. Such immunodeficiency could be secondary to a disease, malignancy, or therapy such as chemotherapy. Just like the prior recommendation, it is recommended for these individuals to receive two doses of Shingrix for the prevention of shingles and its complications. However, the interval between the two doses can be shortened from the recommended 2-6 months to 1-2 months if the person will be going through intense immunosuppression in the upcoming months. This shortened interval will prevent vaccination during an intense immunosuppressed state. The second dose must not be given before one month. 7. When to get vaccinated? Prabhjot: Ideally, one should get vaccinated before starting immunosuppressing therapy; if this cannot be possible, then one should aim for vaccination when their immune response is likely to be the strongest. For example, if it's an immunity-changing disease such as malignancy, the vaccine would be ideal in the beginning stages, and if a person will receive chemotherapy, it would be ideal to vaccinate before starting chemo. 8. Few recommendations from CDC: For Hematopoietic cell transplant: Administer Shingrix at least 3-12 months after transplantation. It is important to consider the vaccine is recommended 2 months before the prophylactic antiviral therapy is discontinued. Since the prophylactic antiviral therapy is also protecting against shingles, the vaccine is preferred to be injected while the antiviral therapy is going on. Arreaza: For allogeneic HCT (when donor is another person), Shingrix should be given a little bit later, 6-12 months after transplant, prior to discontinuation of antiviral therapy. Acyclovir, famciclovir, and valacyclovir will not neutralize the effectiveness of Shingrix because the vaccine is not a live virus vaccine. For cancers: It is ideal to administer Shingrix before chemo, immunosuppressive medications, radiation, or splenectomy. If that is not possible for some reason, administer the vaccine when the patient is stable and not acutely suppressed. For patients on long-term immunosuppressive therapies, administer the vaccine when the immune response is most likely the strongest or right before starting the next cycle of therapy. For patients with HIV: Prabhjot: Shingrix is recommended for patients with HIV due to the high risk of shingles. Immune response to the vaccine may be improved while the patient is on antiretroviral treatment. Bottom line: Shingrix is now recommended not only for those over 50 years old but also for those who are 18 and older and are immunosuppressed or will be on immunosuppressive therapy. This new change will benefit those who are receiving treatment and those who are awaiting treatment. Keep in mind to use the vaccine to prevent shingles and its complications. ________________________________________________________________________________________________________________ Conclusion: Now we conclude our episode number 109, “Shingles vaccine before 50.” We are used to giving Shingrix to patients older than 50, but we were reminded today that it is also indicated in patients older than 18 who are or will be immunosuppressed. Shingrix should be given in 2 doses 2-6 months apart. Your patients may not notice it, but by giving this vaccine, you are PREVENTING a painful rash that can have long-term effects. This week we thank Jennifer Thoene, Hector Arreaza, Prabhjot Kaur, and Arianna Lundquist. Audio edition by Adrianne Silva. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! ________________________________________________________________________________________________________________ References: Bogenschutz MP, Ross S, Bhatt S, et al. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Published online August 24, 2022. doi:10.1001/jamapsychiatry.2022.2096. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2795625. Osborne, Margaret. Psychedelic ‘Magic Mushroom' Ingredient Could Help Treat Alcohol Addiction, Smart News, Smithsonian Magazine, https://www.smithsonianmag.com/smart-news/psychedelic-magic-mushroom-ingredient-could-help-treat-alcohol-addiction-180980658/ “Shingles Vaccination.” Centers for Disease Control and Prevention, page last reviewed: 24 May 2022, https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html. “Clinical Considerations for Use of Recombinant Zoster Vaccine (RZV, Shingrix) in Immunocompromised Adults Aged ≥19 Years.” CDC.gov, 20 Jan. 2022. https://www.cdc.gov/shingles/vaccination/immunocompromised-adults.html. “Shingles.” Mayo Clinic, 17 Sept. 2021, https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054. Royalty-free music used for this episode: Salsa Trap by Caslo, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/caslo/caslo-vol-1/salsa-trap/. Space Orbit by Scott Holmes, downloaded on July 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.

Episode 105: Antidotes to toxidromes. Some poisonings share common signs and symptoms and may be treated with antidotes without laboratory confirmation of the offending agent. Dr. Francis discussed with Dr. Arreaza some of those toxidromes and how to treat them. Written by Aida Francis, MD. Participation by Hector Arreaza, MD. Definitions: • Antidotes are substances given as a remedy that inhibit the effects of another drug of abuse or poison. Most are not 100% effective and fatality is still possible after administration. • Toxidrome is a constellation of signs and symptoms caused by an overdose or exposure to chemicals or drugs that interact with neuroreceptors. Toxidrome is the combination of the word “toxin” and “syndrome”. Management strategies of toxidromes are determined by the signs and symptoms even when the causative agent has not been identified. A little bit of Background: The World Health Organization reported that 13% of deaths caused by poisonings are children and young adults. Intentional poisoning attempts are more frequent among adolescent women than men. It is difficult to evaluate poisoned patients because they are too altered to provide history and there is often not enough time to perform a physical exam or obtain serum studies prior to life-saving interventions. To diagnose a toxidrome clinically, you need three elements: pupil size, temperature, and bowel sounds. For example: Pinpoint pupils with hyperactive bowel sounds point to cholinergic toxidrome, and dilated pupils with high temperature, and hypoactive bowel sounds point to anticholinergic (see details below). Pinpoint pupils -> Bowel sounds -> Hyperactive: CHOLINERGIC -> Hypoactive: OPIOIDS Normal or dilated pupils -> Temperature -> High -> Bowel sounds -> Hyperactive: SYMPATHOMIMETIC -> Hypoactive: ANTICHOLINERGIC -> Normal or Low -> Bowel sounds -> Hyperactive: HALLOCUNOGENIC -> Hypoactive: SEDATIVE-HYPNOTICS Anticholinergic Toxidrome and the Physostigmine antidote: • Anticholinergics inhibit the binding of acetylcholine to the muscarinic receptors in the central nervous system and the parasympathetic nervous system. Examples of anticholinergics include atropine and tiotropium. Other substances that may cause anticholinergic toxidrome include antihistamines (especially first-generation: diphenhydramine), antipsychotics (quetiapine), antidepressants (TCAs, paroxetine), and antiparkinsonian drugs (benztropine). Symptoms of toxicity include tachycardia, non-reactive mydriasis, anhidrosis, dry mucous membranes, skin flushing, decreased bowel sounds, and urinary retention. Neurological symptoms include delirium, confusion, anxiety, agitation, mumbling, visual hallucination, and strange behavior. Neurological symptoms last longer because of the anticholinergic lipophilic properties which cause them to distribute into fatty organs and tissues like the brain. “Mad as a hatter, red as a beet, blind as a bat, hot as a hare, dry as a bone” [Spanish: loco como una cabra, rojo como un tomate, ciego como un topo, seco como una piedra, caliente como el infierno] • The antidote for anticholinergic toxidrome is physostigmine. It is an acetylcholinesterase inhibitor and prevents the metabolism of acetylcholine. This increases the level of acetylcholine in both the central nervous system and peripheral nervous system. Physostigmine can cause seizures and arrhythmia, so close monitoring in the hospital is required during treatment. Cholinergic toxidrome and its antidotes atropine and pralidoxime: Acetylcholine is part of the parasympathetic nervous system and cholinergic substances can induce a parasympathetic response. Some of these substances include pesticides, organophosphates, carbamate, and nerve gas. Chlorpyrifos had been used to control insects in homes and fields since 1965. It has been used in our crops in Bakersfield, and the most recent mass exposure was in May 2017. it was banned on food crops in the US in August 2021. It has been banned for residential use for a longer period. Repeated exposure to chlorpyrifos causes autoimmune disorders and developmental delays in children and fetuses. The symptoms of cholinergic toxidrome can be summarized with the SLUDGE/ “triple” BBB acronym. This includes salivation, lacrimation, urination, defecation, gastrointestinal cramping, emesis, bradycardia, bronchorrhea, and bronchospasm. There can also be muscle fasciculations and paralysis. • The antidote is Atropine. Pralidoxime is used for organophosphates only because it cleaves the organophosphate-acetylcholinesterase complex to release the enzyme to degrade acetylcholine. Pralidoxime should be used in combination with atropine, not as monotherapy. It requires hospital admission, and a note for organophosphate, remember that the patient needs external decontamination (shower). Let's go to part 2 of our discussion, environmental exposure. Carbon Monoxide Toxidrome and the antidote oxygen: Carbon monoxide intoxication is usually due to smoke inhalation injury. Carbon monoxide is a silent gas produced by carbon-containing fuel or charcoal. Carboxyhemoglobin (COHb) forms in red blood cells when hemoglobin combines with carbon monoxide, reducing the binding and availability of oxygen at the tissue level. It's like CO falls in love with hemoglobin and hemoglobin cheats on Oxygen by binding to CO instead, and neglects oxygen delivery to tissues. Carbon monoxide also causes direct cellular toxicity. The symptoms and signs of poisoning include headache, altered mental status, nausea, vomiting, visual disturbance, Cherry-red lips, coma, and seizure. You can also see lactic acidosis and pulmonary edema. Neurological symptoms can be chronic, so it's important to follow up. The blood COHb level must be used to confirm the diagnosis because standard pulse oximetry (SpO2) and arterial partial oxygen pressure (PaO2) cannot differentiate COHb from normal oxygenated hemoglobin. You must obtain a serum COHb level. • The antidote is 100% oxygen or hyperbaric oxygen therapy and close follow-up. Consider intubating if there is edema of the airways due to inhalation injury. Cyanide Toxidrome which include sodium nitrite, sodium thiosulfate, and hydroxocobalamin In combination with Carbon Monoxide poisoning Cyanide poisoning can simultaneously be caused by inhalation of smoke or colorless hydrogen cyanide or ingestion of cyanide salts or prolonged use of sodium nitroprusside (ICU for hypertensive emergency). Symptoms are very similar to carbon monoxide poisoning. There may be long-term neurologic deficits and Parkinsonism. Diagnosis is clinical and waiting for serum cyanide levels can cause treatment delay. However, serum lactate levels over 10 mmol/L suggest cyanide poisoning. • Since cyanide poisoning resembles carbon monoxide poisoning and both toxidromes typically present simultaneously in the pathognomonic fire victim, treat simultaneously with sodium nitrite, sodium thiosulfate, and hydroxocobalamin as well as oxygen as mentioned with carbon monoxide poisoning. Hypnotic and sedative substances (antidote: flumazenil) Examples of hypnotic or sedative substances are alcohol, benzodiazepines, or zolpidem. Signs and symptoms of toxicity include slurred speech, ataxia, incoordination, disorientation, stupor, and coma with mild and rare hypoventilation and bradycardia. • The antidote is flumazenil which is a competitive antagonist at the benzodiazepine receptor. After treatment monitor patients for seizures in case of TCA poisoning, arrhythmia, or epilepsy. Opioid toxidrome (antidote: naloxone) Examples of opioid intoxication in children would be heroine in adolescents or accidental ingestion of pain medication in young children. Signs and symptoms are similar to the sedative toxidrome except for the pathognomonic finding of miosis or “pinpoint pupils” on physical exam. There will also be respiratory depression, hyporeflexia, bradycardia, muscle rigidity, and absent bowel sounds or constipation. Hypoventilation is severe and can cause death. • The antidote is naloxone which is a synthetic opioid receptor antagonist that can diagnose and treat opioid poisoning. It is indicated if the respiratory rate is less than 12. It has a short half-life and is repeatedly administered every 3-5 minutes until the respiratory drive is restored in order to avoid rebound respiratory depression and intubation. It has a rapid onset so the patient must be observed for 24 hours for opioid withdrawal symptoms. Summary: It is important to be able to recognize a toxidrome and antidote early. Once the antidote is administered, you should observe the patient 24 hours for symptoms of rebound toxicity or withdrawal. Consider repeat administration of the antidote if rebound symptoms occur and treat withdrawal symptoms as needed. Don't forget to consider multidrug poisoning if symptoms are non-specific. Thank you for having me on your podcast to review this topic. ____________________________ Conclusion: Now we conclude our episode number 108, “Antidotes to Toxidromes.” Remember you can start treatment of a patient with typical signs and symptoms of specific toxidromes, especially in patients who are unstable. We hope you enjoyed this episode. We thank Hector Arreaza, Aida Francis, and Arianna Lundquist. Audio Edition by Adrianne Silva. Even without trying you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________ References: 1) Jaelkoury, CC BY-SA 3.0 , via Wikimedia Commons. 2) Hon KL, Hui WF, Leung AK. Antidotes for childhood toxidromes. Drugs Context. 2021;10:2020 11-4. Published 2021 Jun 2. doi:10.7573/dic.2020-11-4, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177957/. 3) Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.

Episode 106: Weight Loss Meds. Anti-obesity medications are FDA-approved drugs to support your patient's efforts to lose weight. It is important for primary care providers to learn about these medications to continue fighting against obesity in our communities.Introduction: Obesity is a chronic disease.By Hector Arreaza, MD. Obesity has all the characteristics of a chronic disease. Let's use our imagination and think about a patient with hypertension, for example. Let's imagine you are the doctor or Mr. Lee. He is 45 years old and his blood pressure has been persistently high, around 150/100, even after lifestyle modifications. You decide to start chlorthalidone 25 mg and Mr. Lee takes chlorthalidone every day. Four weeks later you see Mr. Lee again and you review his labs with him. He has normal renal function and normal electrolytes. His blood pressure is now 119/75. He is feeling great and reports no side effects to chlorthalidone. Would you stop the medication at this time? Think about it. The most obvious answer is NO, you will not stop chlorthalidone. Today you will listen to a discussion about anti-obesity medications, common indications, contraindications, cautions, and more. We will learn that obesity requires chronic treatment with medications just like any other chronic disease. I hope you enjoy it.This is the Rio Bravo qWeek Podcast, 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. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.___________________________Weight Loss Meds. By Sapna Patel, MS4; and Danish Khalid, MS$. Ross University School of Medicine. Moderated by Hector Arreaza, MD. S: Hello and welcome back to our nutrition series! If you haven't already listened to our previous episodes, pause this and make sure to give them a listen. We have talked about physical activity, meal plans, and intermittent fasting. Today we are going to talk about the clinical management of obesity, specifically the pharmacotherapy that is used. We will divide these drugs into drugs that reduce food intake primarily acting on the CNS, drugs that reduce fat absorption and medications that are associated with weight gain. D: Can anyone who is considered obese take medications to help them lose weight? Pharmacotherapy should be considered if the patient will be taking the medication in conjunction with the overall weight management program, including changes in eating habits, increased physical activity, and realistic expectations of the medication therapy. Adjuvant pharmacologic treatments should be considered for patients with a BMI >30 kg/m2 or with BMI >27 kg/m2 who have concomitant obesity related diseases. A: You are going to find doctors who are pretty much against anti-obesity drugs, but that's not my case.  S: Drugs that reduce food intake primarily acting on the CNS: Let's start with Phentermine and other sympathomimetic drugs A: Phentermine has been in the market over 60 years and it is well tolerated by most patients. It is effective, expect 5-8 lbs weight loss a month when taken with dietary changes and increased physical activity. The weight loss happens mostly the first 3-6 months when you take anti-obesity medications. S: One of the longest clinical trials of the drugs in this group lasted 36 weeks and compared placebo treatment to treatment with continuous phentermine and intermittent phentermine. Both the continuous and intermittent phentermine therapy produced more weight loss than placebo. D: Other options are Phentermine and topiramate ER which is known as  “Qsymia”. These drugs combine a catecholamine releaser and anticonvulsant respectively.  Topiramate is currently approved by the USFDA as an anticonvulsant for treatment of epilepsy and for prophylaxis of migraine headaches. Weight loss was seen as an unintentional side effect during clinical trials for epilepsy.The mechanism responsible for this is thought to be mediated through the modulation of GABA receptors, inhibition of carbonic anhydrase and antagonism of glutamate to reduce food intake The common adverse effects include cognitive impairment, paresthesia, and increased risk for kidney stones. Topiramate is also a teratogenic drug, so patients need to be in a good birth control to take it. It causes cleft palate in the fetus.The 2 phase-III trials called EQUIP and CONQUER, both 1 year randomized  placebo-controlled double-blinded clinical trials, 3 different strengths of a once-a day formulation were tested: full strength dose (15 mg of phentermine and 92 mg of topiramate ER), mid-dose (7.5mg of phentermine and 92 mg topiramate ER) and low dose (3.75mg of phentermine and 23 mg of topiramate ER). Subjects  randomized to the full strength dose in EQUIP and CONQUER trials lost an average of 10.9% and 9.8% body weight in 1 year compared to 1.6% and 1.2% loss for placebo subjects respectively. Significant improvement in fasting glucose, insulin, Hemoglobin A1C and lipid profile were seen.Due to the dose dependent side effects of the medications an initial dose of 3.75/23 mg is prescribed daily for the first 14 days then increased to 7.5/23mg daily. These patients should be re-evaluated after 3 months. If 3% weight loss is not achieved by that time, either discontinue or escalate the dose to 15/92mg for 12 weeks. S: Drugs that reduce fat absorption:Orlistat. What is orlistat? Well it's a selective inhibitor of pancreatic lipase that reduces the intestinal digestion of fat. The mean weight loss when compared to a placebo was 2.51kg at 6 months and 2.75kg at 12 months. A: It is one of the few anti-obesity medications approved to be used in children 12 years and older. D: GLP-1 Receptor Agonist (-glutide): Semaglutide and Liraglutide - Only two that have been approved for treatment of obesity. A 20-week randomized trial, comparing Liraglutide, placebo, and orlistat, showed that patients assigned to liraglutide lost significantly more weight than those assigned to both. When compared to placebo, those on liraglutide lost a mean weight loss of 2.8 kg. Whereas compared to orlistat lost an average of 5.8kg, however this was on the higher doses of liraglutide. A 56-weeks trial, comparing liraglutide with placebo, showed a mean weight loss was significantly greater in the liraglutide group (8.0 kg vs 2.6 kg). Furthermore, those who initially lost weight with diet and exercise, a greater proportion of those taking liraglutide maintained the weight loss.  Similarly, clinical trials favored semaglutide, with a weight loss greater in the semaglutide group versus placebo. For both, weight loss occurred in patients with and without diabetes. Note: Semaglutide: once a week. Helps induce weight loss. Liraglutide: daily.  A: We dedicated a whole episode on Semaglutide and another whole episode on Tirzepatide. Tirzepatide (dual agonist: GLP-1 and GIP) seems promising for weight loss and it is likely to be approved soon for obesity treatment. So, when do we discontinue anti-obesity medications? We can ask the same question for other chronic diseases: When do we stop medication for hypertension or diabetes? When we have a patient is unable to keep their weight off, we can't see him/her as someone who has lost their motivation to keep their weight off. Really what's happened is that their hormones have changed in a way that is promoting weight gain and it's very hard to lose weight. We should be at the patient's side to fight it off. Conclusion: Now we conclude our episode number 106 “Weight Loss Meds.” Phentermine is the most widely used anti-obesity medication. It is a stimulant, and it is a safe and effective medication for most patients who are fighting obesity. Make sure you learn the contraindication, side effects, and precautions when you prescribe it. Also, learn about other meds that are very effective, including GLP-1 receptor agonists, and your patients will thank you. This week we thank Hector Arreaza, Danish Khalid, and Sapna Patel. Audio by Sheila Toro.Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References: Perreault, L., Apovian, C. (2021). Obesity in adults: Overview of management. Pi-Sunyer,  F.X., Seres, D., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-overview-of-management?search=weight%20loss%20medications&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 Perreault, L. (2022). Obesity in adults: Drug therapy. Pi-Sunyer,  F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-drug-therapy?search=weight%20loss%20medications&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Dungan, K., DeSantis, A. (2022) Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. Nathan, D.M., & Mulder, J.E. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus?search=glp%201%20receptor%20agonists&source=search_result&selectedTitle=2~97&usage_type=default&display_rank=1 Perreault, L., Bessesen, D. (2022). Obesity in adults: Etiologies and risk factors. Pi-Sunyer,  F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-etiologies-and-risk-factors?search=medication%20associated%20with%20weight%20gain§ionRank=1&usage_type=default&anchor=H1612312650&source=machineLearning&selectedTitle=1~150&display_rank=1#H1612312650. Royalty-free music used for this episode: Salsa Trap by Caslo, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/caslo/caslo-vol-1/salsa-trap/. Space Orbit by Scott Holmes, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.  

Neste episódio do E Tem Mais, Carol Nogueira apresenta um panorama das mais recentes iniciativas e investimentos voltados para a exploração espacial. Lançado em dezembro do ano passado, o telescópio James Webb começou a enviar novas imagens do espaço nos últimos dias, e a expectativa é que as luzes infravermelhas captadas pelo equipamento ajudem os cientistas a compreender melhor a formação de estrelas, a atmosfera de planetas fora do Sistema Solar e a própria origem do universo. Na última semana, a Nasa também anunciou que pretende lançar no próximo dia 29 de agosto a primeira missão não tripulada de retorno à Lua. O projeto está inserido no cenário de uma nova corrida espacial, que inclui países como China e Índia, além de empresas como a SpaceX e a Blue Origin. Para descrever as expectativas e a importância dos novos capítulo da jornada humana em busca de mais conhecimento sobre o universo, participam deste episódio o astrofísico Rogemar Riffel, professor da Universidade Federal de Santa Maria (UFSM), e o divulgador científico Pedro Pallotta, do canal Space Orbit. Com apresentação de Carol Nogueira, este podcast é produzido pela Maremoto para a CNN Brasil. Você também pode ouvir o E Tem Mais no site da CNN Brasil. E aproveite para conhecer os nossos outros programas em áudio. Acesse: cnnbrasil.com.br/podcasts.

Neste episódio do E Tem Mais, Carol Nogueira apresenta um panorama das reações ao anúncio de que a Estação Espacial Internacional (ISS, na sigla em inglês) será aposentada pela Nasa até o fim de 2030. A ISS começou a ser construída em 1998, a partir de uma iniciativa conjunta de Estados Unidos, União Europeia, Rússia, Japão e Canadá. De lá para cá, a estação de aproximadamente 400 toneladas já foi palco para mais de 2,5 mil experimentos científicos. Essa história, no entanto, está com os dias contados. O alto custo de manutenção do equipamento é um dos principais motivos para a aposentadoria, e a ISS terminará dentro de alguns anos no fundo do Oceano Pacífico. Os norte-americanos prometem levar o seu programa espacial em frente apostando na parceria com a iniciativa privada. Por outro lado, russos e chineses já desenvolvem as suas próprias estações estatais. Para descrever o que representa o fim da ISS e quais as perspectivas para o futuro da exploração espacial, participam deste episódio o divulgador científico Pedro Pallotta, do canal Space Orbit, e o astrônomo Thiago Gonçalves, do Observatório do Valongo, da Universidade Federal do Rio de Janeiro (UFRJ). Com apresentação de Carol Nogueira, este podcast é produzido pela Maremoto para a CNN Brasil. Você também pode ouvir o E Tem Mais no site da CNN Brasil. E aproveite para conhecer os nossos outros programas em áudio. Acesse: cnnbrasil.com.br/podcasts.

O papo hoje é com Pedro Pallotta do Space Orbit. Vamos falar muito sobre astronomia, astronáutica, cosmos, entender um pouco sobre tudo. Bora conversar ? Seja membro deste canal e ganhe benefícios: https://www.youtube.com/channel/UC-jg... O bate-papo vai rolar!! INSCREVA-SE PARA MANDAR SUA MENSAGEM!! Mande suas perguntas por SuperChat para ficar em DESTAQUE Nos ajude a continuar o PodCast, contribua com qualquer valor PIX - istonaoepodcast@gmail.com _______________________________________ INSCREVA-SE NO NOSSO CANAL, NÃO CUSTA NADA E AJUDA MUITO!

Saudações espaciais, ouvinte inveterado! Neste episódio Leo Lopes, Jéssica Dalcin, Júlio Macoggi e Thiago Fujiwara colocam seus trajes espaciais e reservam um estoque de Dramin pra bater um papo com nosso amigo Pedro Pallotta não como integrante dessa bagaça, mas como o produtor do canal Space Orbit no YouTube, pra explicar por que nenhum de nós vai chegar a fazer uma viagem espacial! Além de conhecer mais sobre o canal Space Orbit, você vai se surpreender ao descobrir que foguete tem marchá a ré, imaginar o preço do pão de queijo no Graal na Lua, analisar a alternativa de ir para o espaço de carro e tomar cuidado pra "não dar uma entortadinha na hora de entrar", entre outras maluquices! Não deixe de interagir com a gente nas redes sociais, dar seu feedback sobre o papo e sugerir temas e convidados para as próximas edições do nosso podcast, além de deixar seu comentário no post, ok? Você também pode agora mandar sua cartinha para a Caixa Postal 279 - CEP 13930-970 - Serra Negra - SP, e seu e-mail para podcast@radiofobia.com.br! Links citados no episódio: - EU NÃO ACREDITO - Turismo Espacial Links citados nas Cartinhas do Totô: - Podcast O Mundo do Charuto, com Cesar Adames - participe do grupo de produtores, apresentadores e ouvintes dos podcasts da Rádiofobia Podcast Network no Telegram - assine o canal da Rádiofobia Podcast Network no YouTube! - assine o canal da Rádiofobia Podcast Network no Twitch! - Rádiofobia Podcast Network no Apple Podcasts - Rádiofobia Podcast Network no Spotify - Siga @radiofobialhes no tuVítter - Curta a página do Radiofobia Podcast no Facebook Ouça o Rádiofobia Podcast nos principais agregadores: - Spotify - Google Podcasts - Apple Podcasts - Amazon Music - PocketCasts Publicidade: Entre em contato e saiba como anunciar sua marca, produto ou serviço em nossos podcasts.

Saudações espaciais, ouvinte inveterado! Neste episódio Leo Lopes, Jéssica Dalcin, Júlio Macoggi e Thiago Fujiwara colocam seus trajes espaciais e reservam um estoque de Dramin pra bater um papo com nosso amigo Pedro Pallotta não como integrante dessa bagaça, mas como o produtor do canal Space Orbit no YouTube, pra explicar por que nenhum de nós vai chegar a fazer uma viagem espacial! Além de conhecer mais sobre o canal Space Orbit, você vai se surpreender ao descobrir que foguete tem marchá a ré, imaginar o preço do pão de queijo no Graal na Lua, analisar a alternativa de ir para o espaço de carro e tomar cuidado pra "não dar uma entortadinha na hora de entrar", entre outras maluquices! Não deixe de interagir com a gente nas redes sociais, dar seu feedback sobre o papo e sugerir temas e convidados para as próximas edições do nosso podcast, além de deixar seu comentário no post, ok? Você também pode agora mandar sua cartinha para a Caixa Postal 279 - CEP 13930-970 - Serra Negra - SP, e seu e-mail para podcast@radiofobia.com.br! Links citados no episódio: - EU NÃO ACREDITO - Turismo Espacial Links citados nas Cartinhas do Totô: - Podcast O Mundo do Charuto, com Cesar Adames - participe do grupo de produtores, apresentadores e ouvintes dos podcasts da Rádiofobia Podcast Network no Telegram - assine o canal da Rádiofobia Podcast Network no YouTube! - assine o canal da Rádiofobia Podcast Network no Twitch! - Rádiofobia Podcast Network no Apple Podcasts - Rádiofobia Podcast Network no Spotify - Siga @radiofobialhes no tuVítter - Curta a página do Radiofobia Podcast no Facebook Ouça o Rádiofobia Podcast nos principais agregadores: - Spotify - Google Podcasts - Apple Podcasts - Amazon Music - PocketCasts Publicidade: Entre em contato e saiba como anunciar sua marca, produto ou serviço em nossos podcasts.

Eu não acredito que vamos poder viajar para o espaço como turistas! Ainda que esse sonho leve décadas pra se realizar, o fato é que a era do turismo espacial começou, e começou com tudo, com ricaços do planeta fazendo sua própria versão da corrida espacial. Nesta semana, vamos entender todos os detalhes do desenvolvimento e viabilidade do turismo espacial nos próximos anos, com Marcel Campos do MC 1:1 e Pedro Pallotta do canal Space Orbit. Gostou do episódio? Mande um comentário em áudio pelo WhatsApp +55 11 98765-6950. Seu comentário poderá aparecer no podcast Serviço de Atendimento à Cavalaria (SAC). Saiba mais em www.redegeek.com.br

Eu não acredito que vamos poder viajar para o espaço como turistas! Ainda que esse sonho leve décadas pra se realizar, o fato é que a era do turismo espacial começou, e começou com tudo, com ricaços do planeta fazendo sua própria versão da corrida espacial. Nesta semana, vamos entender todos os detalhes do desenvolvimento e viabilidade do turismo espacial nos próximos anos, com Marcel Campos do MC 1:1 e Pedro Pallotta do canal Space Orbit. Gostou do episódio? Mande um comentário em áudio pelo WhatsApp +55 11 98765-6950. Seu comentário poderá aparecer no podcast Serviço de Atendimento à Cavalaria (SAC). Saiba mais em www.redegeek.com.br

Searching for meaning in the choices society makes, finding personal responsibility in space travel and are carbon credits absolved in lower "shit space" orbit tourism. The news feed is littered with challenges and internal conflicts for a thinking member of the community and mental health should be a daily consideration for those who question the status quo and not left to an annual RUok day The Shed also grapples with its reverse sponsorship conundrum and is free merch at the bottle shop actual a form of sponsorship Dry July has nothing to do with adult bedwetting. Who knew? Has the CIA run out of unsavoury dictators? Tangents and all the usual segment like Mick's Memes Film/Doco recommendations: Gaza Fights for Freedom is now available free on the youtube Earth's Greatest Enemy Judas and the Black Messiah The Dissident

Pedro Pallotta é host do Space Orbit, amante de foguetes e exploração espacial.

SÉRGIO SACANI e PEDRO PALLOTTA são amantes do vasto vazio chamado espaço sideral. Sérgio tem o canal SPACE TODAY, com fatos e curiosidades sobre tecnologia espacial e o Universo, e Pedro é dono do SPACE ORBIT, um canal mais voltado para o lançamento de foguetes e história dos programas espaciais. Já o Vilela está até hoje tentando manter contato com seu planeta natal.   Assista ao episódio também no Youtube: https://youtu.be/SKhtfuupjlo   Estamos transmitindo nossas lives também na Twitch!! https://www.twitch.tv/inteligencialimitada   Quer mandar presentes para nós?  CAIXA POSTAL 81969 | CEP: 05619-970 | São Paulo - SP

SÉRGIO SACANI e PEDRO PALLOTTA são amantes do vasto vazio chamado espaço sideral. Sérgio tem o canal SPACE TODAY, com fatos e curiosidades sobre tecnologia espacial e o Universo, e Pedro é dono do SPACE ORBIT, um canal mais voltado para o lançamento de foguetes e história dos programas espaciais. Já o Vilela está até hoje tentando manter contato com seu planeta natal.   Assista ao episódio também no Youtube: https://youtu.be/SKhtfuupjlo   Estamos transmitindo nossas lives também na Twitch!! https://www.twitch.tv/inteligencialimitada   Quer mandar presentes para nós?  CAIXA POSTAL 81969 | CEP: 05619-970 | São Paulo - SP See omnystudio.com/listener for privacy information.

Essa semana os hosts JP Miguel (@JP_miguel), Gustavo Rebello (@Gu_rebel), e Isabela Fontanella (@bellafontanella) receberam Pedro Palotta (@PallottaPedro) do Space Orbit, para bater um papo sobre a nova corrida espacial, o que está em jogo de fato, qual o posicionamento de muitos países nessa empreitada e o futuro. O figuraça da semana é Joe Exotic, o popular Tiger King, enquanto que o destaque bizarro vem por conta dos novos confinamentos na Austrália. Na economia o mercado global de cannabis, enquanto que o meio ambiente destaca o clima e as queimadas do oeste Americano. Além é claro do obituário da semana, o recado dos ouvintes, do calendário e da dica cultural! Lembrando sempre que mandem sugestões, críticas, etc para contato@opodnext.com, ou ainda pelo site: opodnext.com E BORA PRO PROGRAMA!

Saudações geopolíticas, ouvinte desocupado! No programa de hoje Leo Lopes, Jéssica Dalcin e Pedro Pallotta abrem seus jornais e tiram seus passaportes da gaveta pra bater um papo sobre geopolítica e conhecer a história podcastal de Isabela Fontanella, Gustavo Rebelo e JP Miguel diretamente do Podnext! Você vai ouvir a história de como eles se conheceram, entender como surgiu a ideia do Podnext e por que o início do projeto coincidiu com o começo da pandemia em março de 2020, quais as fontes que a equipe usa pra se informar e como decidem as pautas de cada episódio, saber a diferença entre filtrar e processar a informação e muito mais! Não deixe de interagir com a gente nas redes sociais, dar seu feedback sobre o papo e sugerir temas e convidados para as próximas edições do nosso podcast, além de deixar seu comentário no post, ok? Você também pode agora mandar sua cartinha para a Caixa Postal 279 - CEP 13930-970 - Serra Negra - SP, e seu e-mail para podcast@radiofobia.com.br! Links citados no episódio: - Podnext - PodNext #60 – Circus Brasilis - PodNext #59 – E Gaza Hein? - Space Orbit, o canal do Pedro sobre foguetes no YouTube - assine o Podnext Confidencial Links citados nas Cartinhas do Totô: - RádiofoBeer #026 – Paladar infantil cervejeiro - QueIssoAssim 231 – O Importante é o Cara Ter (Retroceder Nunca, Render-se Jamais – 1986) - participe do grupo de produtores, apresentadores e ouvintes dos podcasts da Rádiofobia Podcast Network no Telegram - assine o canal da Rádiofobia Podcast Network no YouTube! - assine o canal da Rádiofobia Podcast Network no Twitch! - Rádiofobia Podcast Network no Apple Podcasts - Rádiofobia Podcast Network no Spotify - Siga @radiofobialhes no tuVítter - Curta a página do Radiofobia Podcast no Facebook Ouça o Rádiofobia Podcast nos principais agregadores: - Spotify - Google Podcasts - Apple Podcasts - Amazon Music - PocketCasts Publicidade: Entre em contato e saiba como anunciar sua marca, produto ou serviço em nossos podcasts. See omnystudio.com/listener for privacy information.

Saudações geopolíticas, ouvinte desocupado! No programa de hoje Leo Lopes, Jéssica Dalcin e Pedro Pallotta abrem seus jornais e tiram seus passaportes da gaveta pra bater um papo sobre geopolítica e conhecer a história podcastal de Isabela Fontanella, Gustavo Rebelo e JP Miguel diretamente do Podnext! Você vai ouvir a história de como eles se conheceram, entender como surgiu a ideia do Podnext e por que o início do projeto coincidiu com o começo da pandemia em março de 2020, quais as fontes que a equipe usa pra se informar e como decidem as pautas de cada episódio, saber a diferença entre filtrar e processar a informação e muito mais! Não deixe de interagir com a gente nas redes sociais, dar seu feedback sobre o papo e sugerir temas e convidados para as próximas edições do nosso podcast, além de deixar seu comentário no post, ok? Você também pode agora mandar sua cartinha para a Caixa Postal 279 - CEP 13930-970 - Serra Negra - SP, e seu e-mail para podcast@radiofobia.com.br! Links citados no episódio: - Podnext - PodNext #60 – Circus Brasilis - PodNext #59 – E Gaza Hein? - Space Orbit, o canal do Pedro sobre foguetes no YouTube - assine o Podnext Confidencial Links citados nas Cartinhas do Totô: - RádiofoBeer #026 – Paladar infantil cervejeiro - QueIssoAssim 231 – O Importante é o Cara Ter (Retroceder Nunca, Render-se Jamais – 1986) - participe do grupo de produtores, apresentadores e ouvintes dos podcasts da Rádiofobia Podcast Network no Telegram - assine o canal da Rádiofobia Podcast Network no YouTube! - assine o canal da Rádiofobia Podcast Network no Twitch! - Rádiofobia Podcast Network no Apple Podcasts - Rádiofobia Podcast Network no Spotify - Siga @radiofobialhes no tuVítter - Curta a página do Radiofobia Podcast no Facebook Ouça o Rádiofobia Podcast nos principais agregadores: - Spotify - Google Podcasts - Apple Podcasts - Amazon Music - PocketCasts Publicidade: Entre em contato e saiba como anunciar sua marca, produto ou serviço em nossos podcasts. See omnystudio.com/listener for privacy information.

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Quarta-feira, 25/11/2020. Hoje quem desabafa é o Pedro Pallotta (@porondevamos), host do Space Orbit e integrante do Radiofobia. Vai passar! :)

Gas stations in space! Orbit Fab's CEO, Daniel Faber, is working to build the first and only propellant supply chain in space and make satellites reusable, so we can stop throwing away billions of dollars' worth of fully operational assets every year.  We chatted with Daniel about the need for refueling satellites and how Orbit Fab is providing the infrastructure to increase the lifespan of them. He tells us about tow trucks in space and how his previous company, Deep Space Industries, is working towards the goal of mining asteroids. He also shares lessons learned from being a serial entrepreneur while working on his now fourth start-up space company.