Ticagrelor or Clopidogrel for Antiplatelet Therapy After Percutaneous Intervention for Acute Coronary Syndrome?
30 min

The Platelet Inhibition and Patient Outcomes (PLATO) trial showed that ticagrelor had better outcomes than clopidogrel for avoiding thrombotic complications following acute coronary syndrome. Subsequent trials suggested that the outcomes for the drugs were about the same. The effects of ticagrelor and clopidogrel were examined in a very large observational study performed by Harlan Krumholz, MD, and colleagues, published in the October 27, 2020, issue of JAMA. Dr Krumholz explains how his study was performed and what it showed.

Related Article:

Association of Ticagrelor vs Clopidogrel With Net Adverse Clinical Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

ohdsi.org

Bedside Rounds
Bedside Rounds
Adam Rodman, MD, MPH, FACP
59 - Cry of the Suffering Organs
Diagnosis is arguably the most important job of a physician. But what does it actually mean to make a diagnosis? In this episode, we’ll explore this question by tracking the development of the “classical” model of diagnosis and pathological anatomy and discussing three cases over three hundred years. Along the way, we’ll ponder the concept of the lesion, iatromechanistic theories of the human machine, the birth of the International Classification of Diseases, and the rise and decline of the autopsy. You can sign up for the iMED Digital Education conference at cmeregistration.hms.harvard.edu/digitaleducation. Sources: * Hooper R, The Physician’s Vade-Mecum: Containing the Symptoms, Causes, Diagnosis, Prognosis and Treatment of Diseases. 1812. * Holdman L et al, The Value of the Autopsy in Three Medical Eras. N Engl J Med 1983; 308:1000-1005. * Cabot RC et al. CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITALANTE-MORTEM AND POST-MORTEM RECORDS AS USED IN WEEKLY CLINICO-PATHOLOGICAL EXERCISES. Case 9431. Boston Med Surg J 1923; 189:595-599. * Shojania KG and Burton EC, The Vanishing Nonforensic Autopsy. N Engl J Med 2008; 358:873-875 * Morgagni GB. The seats and causes of diseases investigated by anatomy in five books, containing a great variety of dissections, with remarks. To which are added ... copious indexes. 1769. Retrieved online: https://openlibrary.org/works/OL15821973W/The_seats_and_causes_of_diseases_investigated_by_anatomy * Castiglioni A, GB Morgagni and the Anatomico-pathological Conception of the Clinical. Proceedings of the Royal Society of Medicine, November 7, 1934. * Thiene G, Padua University: The role it has played in the History of Medicine and Cardiology and its position today. European Heart Journal, Volume 30, Issue 6, March 2009, Pages 629–635. * Zampieri F et al, Origin and development of modern medicine at the University of Padua and the role of the “Serenissima” Republic of Venice. Glob Cardiol Sci Pract. 2013; 2013(2): 149–162. * Conner, Annastasia (2017) "Galen’s Analogy: Animal Experimentation and Anatomy in the Second Century C.E.," Anthós: Vol. 8: Iss. 1, Article 9. * Zampieri F et al. The clinico-pathological conference, based upon Giovanni Battista Morgagni's legacy, remains of fundamental importance even in the era of the vanishing autopsy. Virchows Arch. 2015 Sep;467(3):249-54. * Ghosh SK, Giovanni Battista Morgagni (1682-1771): father of pathologic anatomy and pioneer of modern medicine. Anat Sci Int. 2017 Jun;92(3):305-312. * O’Neal JC, Auenbrugger, Corvisart, and the Perception of Disease. Eighteenth-Century Studies Vol. 31, No. 4, The Mind/Body Problem (Summer, 1998), pp. 473-489 * Brown TM, THE COLLEGE OF PHYSICIANS AND THE ACCEPTANCE OF IATROMECHANISM IN ENGLAND, 1665-1695. Bulletin of the History of Medicine Vol. 44, No. 1 (JANUARY-FEBRUARY 1970), pp. 12-30 * Roos AM, Luminaries in Medicine: Richard Mead, James Gibbs, and Solar and Lunar Effects on the Human Body in Early Modern England. Bulletin of the History of Medicine Vol. 74, No. 3 (Fall 2000), pp. 433-457 (25 pages) * Frith J, History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague. JMVH. 2014; 22(2). * World Health Organization, History of the development of the ICD. https://www.who.int/classifications/icd/en/HistoryOfICD.pdf * Laennec RTH, A treatise on diseases of the chest and on mediate auscultation. 1834. Retrieved from: https://archive.org/details/b21987002. * Marinker M, Why make people patients? J Med Ethics. 1975 Jul; 1(2): 81–84. * King LS, Medical Thinking: A Historical Preface. Princeton University Press, 2016.
43 min
The Curbsiders Internal Medicine Podcast
The Curbsiders Internal Medicine Podcast
The Curbsiders
#244 Vulvovaginitis for All Ages with Dr. Monica Christmas
Everything you need to know about vulvovaginitis: candidiasis, bacterial vaginosis, and Genitourinary Syndrome of Menopause. Join us on the journey of a lifetime as we learn all about diagnosing, treating and managing vulvovaginal conditions in patients of all ages. Plus, a bit on how to recognize and treat lichen sclerosus. Our brilliant guest for this episode is Dr. Monica Christmas (_@drmonicaxmas_ on Twitter), who is a self-described yoga enthusiast, avid reader, wannabe artist and gynecologist. Dr. Christmas is currently an _Assistant Professor at the University of Chicago_ in the section of Minimally Invasive Gynecologic Surgery where she is the director of the Menopause Program. Monica specializes in gynecologic surgery, abnormal uterine bleeding and menopause management with an interest in sexual dysfunction. Her focus is on helping women live healthy, vibrant, happy lives. _Episodes_ | _Subscribe_ | _Spotify_ | _Swag!_ | _Top Picks_ | _Mailing List_ | _thecurbsiders@gmail.com_ | _Free CME!_ Credits * Produced by: Kate Grant MD; Sarah Phoebe Roberts MPH * Written by: Kate Grant MD * Show Notes by: Sarah Phoebe Roberts MPH, Kate Grant MD * Cover Art and Infographic: Kate Grant MD * Hosts: Kate Grant MD; Matthew Watto MD, FACP; Paul Williams MD, FACP * Editor: Matthew Watto MD (written materials); Clair Morgan of _nodderly.com_ * Guest: Dr. Monica Christmas, MD Sponsor: ACP’s I Raise the Rates Join with other clinicians in working to raise influenza and other adult vaccination rates. Visit _acponline.org/ai_ to access free tools and learn new strategies to support your efforts. Sponsor: VCU Health CE The Curbsiders are partnering with _VCU Health Continuing Education_ to offer FREE continuing education credits for physicians and other healthcare professionals. Visit _curbsiders.vcuhealth.org_ and search for this episode to claim credit.
57 min
Diabetes Core Update
Diabetes Core Update
American Diabetes Association
Diabetes Core Update – December 2020
Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association’s four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 20 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. This issue will review: * Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure * Impact of Comorbidities and Glycemia at Admission and DPP-4 Inhibitors in Patients With Type 2 Diabetes With COVID-19 * Diabetes as a Risk Factor for Poor Early Outcomes in Patients Hospitalized With COVID-19 * Changes in Statin Use Among U.S. Adults With Diabetes * Dapagliflozin in Patients with Chronic Kidney Disease Study For more information about each of ADA’s science and medical journals, please visit www.diabetesjournals.org. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health
24 min
Cardionerds: A Cardiology Podcast
Cardionerds: A Cardiology Podcast
CardioNerds
90. Case Report: Atrioesophageal Fistula (AEF) Formation after Pulmonary Vein Isolation – Thomas Jefferson University Hospital
CardioNerds (Amit Goyal) joins Thomas Jefferson cardiology fellows (Jay Kloo, Preya Simlote and Sean Dikdan - host of the Med Lit Review podcast) for some amazing craft beer from Independence Beer Garden in Philadelphia! They discuss a fascinating case of atrioesophageal fistula (AEF) formation after pulmonary vein isolation (PVI). Dr. Daniel Frisch provides the E-CPR and program director Dr. Gregary Marhefka provides a message for applicants. Johns Hopkins internal medicine resident Colin Blumenthal with mentorship from University of Maryland cardiology fellow Karan Desai.   Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A mid 60s male with relevant PMHx of paroxysmal atrial fibrillation presents to the ED with altered mental status after one week of mild chest pain. Given the long history of atrial fibrillation refractory to rate and rhythm control with diltiazem and flecainide, he underwent a pulmonary vein isolation 21 days prior to arrival. In the ED, T 39.4 and patient had a witnessed seizure requiring intubation for airway protection. Signs of hypoperfusion on labs, but white blood cell count not elevated. LP negative, but blood cultures positive for strep agalactiae. CT head with multiple tiny foci of intravascular air throughout the brain with MRI consistent with multiple areas of acute infarction. CTA of chest then obtained, which was notable for a small focus of air tracking along the esophagus. Taken together, findings most c/w atrial esophageal fistula causing sepsis and air emboli. Patient underwent surgical repair of left atrium and esophagus with a good outcome.  Case Media ABCDEFClick to Enlarge A. ECG: Normal sinus rhythm HR 105 bpmB. CXRC. CT head: Multiple tiny foci of air throughout bilateral cerebral hemispheres. Appearance is most suggestive of intravascular air, although it is unclear if it is venous, arterial or both.D. MRI: 1. Restricted diffusion in bilateral cortical watershed zones, as well as in the posterior medial left cerebellar hemisphere, most consistent with recent infarctions.E. CT Chest: A small focus of air tracking along the left mainstem bronchus anterior to the esophagus, may represent a small amount of pneumomediastinum versus air in an outpouching of the esophagus. No air tracking more cranially along the mediastinal soft tissues. No definite soft tissue defect in the esophagus.F. Surgical repair of LA & Esophagus Episode Schematics & Teaching Coming soon! The CardioNerds 5! – 5 major takeaways from the #CNCR case Coming soon! References Coming soon! CardioNerds Case Reports: Recruitment Edition Series Production Team Bibin Varghese,
1 hr 12 min
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