Neurology Minute
Neurology Minute
Jan 18, 2021
Updates on the Management of Myasthenia Gravis
Play • 3 min

Dr. Pushpa Narayanaswami discusses the updated 2020 myasthenia gravis consensus guidelines. Show referneces: https://n.neurology.org/content/early/2020/11/03/WNL.0000000000011124

This Week in Cardiology
This Week in Cardiology
Medscape
Feb 26, 2021 This Week in Cardiology Podcast
Risk factors for COVID-19, CMR after COVID-19, and two important obesity studies are discussed in this week’s podcast. To read a partial transcript or to comment https://www.medscape.com/index/twic Cardiometabolic Conditions and COVID19 Most Severe COVID Tied to Four Cardiometabolic Conditions https://www.medscape.com/viewarticle/946488 Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis https://www.ahajournals.org/doi/10.1161/JAHA.120.019259 CMR after COVID19 Myocardial Injury Seen on MRI in 54% of Recovered COVID https://www.medscape.com/viewarticle/946287 Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance https://doi.org/10.1093/eurheartj/ehab075 Obesity Trials Semaglutide for Weight Loss? A Good First STEP, With Caveats https://www.medscape.com/viewarticle/945630 Once-Weekly Semaglutide in Adults with Overweight or Obesity https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 Major Breakthrough in Weight Loss With Semaglutide? https://www.medscape.com/viewarticle/940841 Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity https://jamanetwork.com/journals/jama/fullarticle/2777025 Features Fired for Good Judgment a Sign of Physicians' Lost Respect https://www.medscape.com/viewarticle/946286 A Tribute to Bernard Lown https://www.medscape.com/viewarticle/946447 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net
20 min
Cardionerds: A Cardiology Podcast
Cardionerds: A Cardiology Podcast
CardioNerds
105. Narratives in Cardiology: Racial Disparities in Advanced Heart Failure with Dr. Bryan Smith and Dr. Shirlene Obuobi
CardioNerds (Amit Goyal and Daniel Ambinder) join Dr. Bryan Smith (Advanced Heart Failure and Transplant Cardiologist at the University of Chicago) and Dr. Shirlene Obuobi (rising cardiology fellow, CardioNerds ambassador for the University of Chicago, and creator of ShirlyWhirl, M.D.) They discuss the story of a patient with end stage heart failure due to peripartum cardiomyopathy that highlights racial disparities in healthcare and advanced heart failure. They emphasize the importance of providing mentorship for Black and Indigenous People of Color (BIPOC) and share personal stories of their journey to Cardiology. Dr. Andi Shahu joins us to read his AHA blog titled "Let’s Ban the Phrase “Social Issues”: Social Justice and Advanced Heart Failure Therapies". Audio editing by CardioNerds Academy intern, Pace Wetstein. Collect free CME/MOC credit just for enjoying this episode!  Cardionerds Narratives in Cardiology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll Subscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Quotables: “One of the reasons why I went into Heart Failure is because I connected a lot with these young patients, a lot of these young black men and black women who were terrified of the hospital. As a resident and a fellow I would go talk to them and really understand their fears and where they are coming from. I think a lot of times these patients can be labeled as ‘noncompliant,’ or ‘withdrawn,’ or ‘aggressive,’ but a lot of times you just have to understand where they’re coming from. And I really found that just sitting down to talk to them, and to get to know them, I was able to help get them better, or a lot of them went on to get VADs or transplant. And, to be perfectly honest, I’m in touch with a lot of these patients who I met as a fellow who...I feel are part of my life....You have to meet patients where they are. Meaning you need to text them, interact with them on social media, and really connect with them in a way they understand.” Dr. Bryan Smith (12:10) “Being black in America means not getting the benefit of doubt. ...I can’t help but wonder if unconscious bias among providers is imposing...unreasonable scrutiny on patients of color.” Shirlene (21:15) “There are many different ways to combat [racial] disparities. As a Heart Failure physician we have these multidisciplinary meetings where we discuss patients for transplant. And I think it’s...important to highlight to our providers that how we discuss patients really matters. Language definitely matters. Heart failure is art in addition to science. ...Sometimes when discussing these patients...charged words are used, like ‘withdrawn,’ or ‘aggressive,’ or ‘ghetto’ even. And it’s all coded, racist language. ...Part of our responsibility is to educate everyone with implicit bias training....and to make sure we’re able to advocate for patients in the right way.” Dr. Bryan Smith (22:30) “I’ve felt like I’ve been paying the minority tax...which is doing the necessary but unpaid and frequently seldom recognized labor of mentorship, community engagement, etc, and also of being hyper visible and acting as a symbol...” - Shirlene (24:52) “It’s really easy when patients are in the hospital to think of them only as patients and forget that they’re people too, and that people are complex, they have complex emotions, they have reactions to things, sometimes those reactions aren’t necessarily what we would think are appropriate for their medical situation, but they’re what make us human.” - Shirlene (9:50) Notes: 1. What are some of the racial disparities in diagnosis and outcomes of peri-partum cardiomyopathy, and what are some factors that might be contributing to those disparities? CVD disease is the leading cause of pregnancy-associated mortality in the US. Black and American Indian/ Alaskan Native women are 3-4x more likely to die from a pr...
1 hr 6 min
The Curbsiders Internal Medicine Podcast
The Curbsiders Internal Medicine Podcast
The Curbsiders Internal Medicine Podcast
#259 Addiction Medicine Triple Distilled
Let's recap our favorite addiction medicine pearls! We cover the treatment of alcohol use disorder, opioid use disorder and discuss strategies surrounding the management of long-term opioid therapy. Please share your favorite addiction medicine pearls with us that we may have forgotten in the comments or by tagging us on Twitter @thecurbsiders. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits * Producers: Carolyn Chan MD; Nora Taranto MD * Infographics: Hannah R Abrams; Justin Berk MD, MPH, MBA; Carolyn Chan MD; Nora Taranto MD * Writer and Cover Art: Carolyn Chan, MD * Hosts: Carolyn Chan MD; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP * Editor: Justin Berk MD (written materials); Clair Morgan of nodderly.com Sponsor: Panacea Financial This episode is supported by Panacea Financial, digital banking built for doctors, by doctors. At Panacea Financial, you can have your own free personal banker and a support team that works around the clock- just like you do. Open your free checking account today at panaceafinancial.com Panacea is also excited to announce their “Match Day Giveaway.” $500 will be awarded to five medical students entering the match in 2021. Entry is free, and students can enter the giveaway on their website until March 31, 2021. Winners will be selected randomly on April 1st, 2021. No purchase necessary for entry. Go to panaceafinancial.com/matchday today to learn more. Panacea Financial, a Division of Sonabank, Member FDIC Partner: The Cribsiders Pediatric Medicine Podcast A Pediatric Podcast here to feed pediatric knowledge food to your adult-sized brain hole & provide weight-based dosings of fun. New episodes drop every other Wednesday! https://thecribsiders.com/ CME Partner: VCU Health CE The Curbsiders partner with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org to claim credit. Time Stamps * Intro, disclaimer 00:00 * Alcohol Use disorder (inpatient and outpatient management) 03:50 * Sponsor -Panacea Finanicial 24:00 * Partner -The Cribsiders Pediatric Medicine Podcast * Chronic Pain and Opioid Therapy (prescribing buprenorphine; microdosing) 25:30 * Benzo Tapers 46:11 * Outro
50 min
Pediatric Emergency Playbook
Pediatric Emergency Playbook
Tim Horeczko, MD, MSCR, FACEP, FAAP
Constipation and the way out
Constipation as a diagnosis can be dangerous, mainly because it is a powerful anchor in our medical decision-making. Chances are, you’d be right to chalk up the pain to functional constipation — 90% of pediatric constipation is functional, multifactorial, and mostly benign — as long as it is addressed. We’re not here for “chances are“; we’re here for “why isn’t it?“ Ask yourself, could it be: Anatomic malformations: anal stenosis, anterior displaced anus, sacral hematoma Metabolic: hypothyroidism, hypercalcemia, hypokalemia, cystic fibrosis, diabetes mellitus, gluten enteropathy Neuropathic: spinal cord abnormalities, trauma, tethered cord Neuromuscular: Hirschprung disease, intestinal neuronal dysplasia, myopathies, Down syndrome, prune belly syndrome Connective tissue disorders: scleroderma, SLE, Ehlers-Danlos syndrome Drugs: opioids, antacids, antihypertensives, anticholinergics, antidepressants, sympathomimetics Ingestions: heavy metals, vitamin D overload, botulism, cow’s milk protein intolerance Red Flags Failure to thrive Abdominal distention Lack of lumbosacral curve Midline pigmentation abnormalities of the lower spine Tight, empty rectum in presence of a palpable fecal mass Gush of fluid or air from rectum on withdrawal of finger Absent anal wink You gotta push the boat out of the mud before you pray for rain. — Coach Medications for disimpaction (do this first!) Polyethylene Glycol (PEG) 3350 (Miralax): 1 to 1.5 g/kg PO daily for 3 to 6 consecutive days. Maximum daily dose: 100 g/day PO. Follow-up with maintenance dose (below) for at least 2 months (usually 6 months) Lactulose: 1.33 g/kg/dose (2 mL/kg) PO twice daily for 7 days Mineral Oil (school-aged children): 3 mL/kg PO twice daily for 7 days Medications for Maintenance (do this after disimpaction!) Polyethylene Glycol (PEG) 3350 (Miralax): 0.2 to 0.8 g/kg/day PO. Maximum daily dose: 17 g/day. Maintenance dosing for Miralax may need to be tailored; up to 1 g/day maintenance. Lactulose: 1 to 2 g/kg/day (1.5 to 3 mL/kg/day)PO divided once or twice daily. Maximum daily dose: 60 mL/day in adults. Mineral Oil: 1 to 3 mL/kg/day PO divided in 1 to 2 doses; maximum daily dose: 90 mL/day Docusate (Colace): 5 mg/kg/day PO divided QD, BID, or TID (typical adult dose 100 mg BID) Senna, Bisocodyl — complicated regimens; use your local reference Enemas * Are you sure? Have you tried oral disimpaction over days? * No phosphate enemas for children less than 2. * Saline enemas are generally safe for all ages * Be careful with the specific dose — please use your local reference Selected References Freedman SB et al. Pediatric Constipation in the Emergency Department: Evaluation, Treatment, and Outcomes. JPGN 2014;59: 327–333. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Clinical Practice Guideline: Evaluation and Treatment of Constipation in Infants and Children. JPGN 2006; 43:e1-e13. Tabbers MM et al. Evaluation and Treatment of Functional Constipation in Infants and Children: Evidence-Based Recommendations From ESPGHAN and NASPGHAN. JPGN 2014;58: 258–274. Audio Player 00:00 00:0
49 min
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