Chest pain in an Elderly Woman
This case was sent by one of our great FOAM colleagues, Salim Rezaie of REBEL EM!!"A 67 y/o female with PMH of Type 2 DM, HTN, Hyperlipidemia, and Hx of MI x 2, with chronic kidney disease awoke at 2am with left sided chest pain. She arrived at 2:45 AM and had this initial ECG below:"What do you think? Smith response: There is sinus rhythm. There is No significant ST elevation in any lead. There are large, symmetric T-waves in I, aVL, V2-V5 diagnostic of proximal LAD occlusion. There are also down-up T-waves in III and aVF (these are very specific RECIPROCAL findings and clinch the diagnosis.)Salim was very worried about these T-waves and so brought the patient the Medical Resus room and did an immediate bedside echo (not shown) which he read as a lateral wall motion abnormality; then he activated the cath lab.He recorded a second ECG 5 minutes after the first:Now there is obvious high lateral ST elevation, as well as STE in V2, V3, V4, V5.He writes:"Patient was immediately taken to cath lab. Initial Troponin was (I'm not sure if 0.03 is level of detection or 99% reference, and I did not clarify that with Salim)."We obtained that result after the patient was already gone. Subsequent Troponin I values were 53.6 ng/mL and 152.04 ng/mL." This is a large anterior MI."In my mind this was a circ lesion due to STE elevation in lateral leads, but…."Cath showed:"Prox LAD 70% lesionLarge D1 100% occlusion...
We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION: PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries. PMID: 33034214 [PubMed - as supplied by publisher]
Authors: Musio F Abstract INTRODUCTION: Anemia has and will continue to be a central theme in medicine particularly as clinicians are treating a burgeoning population of complex multi-organ system processes. As a result of multiple randomized controlled trials (RCTs), meta-analyses, and societal recommendations overly restrictive paradigms and under-administration of erythropoiesis stimulating agents (ESAs) have likely been followed by clinicians among all specialties. AREAS COVERED: A review of anemia in the context of chronic kidney disease, hematologic malignancies and cancer is presented with focus on the e...
Publication date: Available online 10 October 2020Source: Journal of Vascular Surgery: Venous and Lymphatic DisordersAuthor(s): N.G. Shah, B.C. Wible, J.A. Paulisi, M. Zaki, P. Lamparello, A. Sista, M. Sadek, G.R. Jacobowitz, T.S. Maldonado
Currently in fellowship doing bread/butter procedures (MBB, epidurals, PNB, few SCS/PNS trials, etc.) and just interviewed at a private practice spot where they do a lot of procedures that I will have not done any training in prior to graduating (e.g. IT pump, SI fusion, Vertiflex, Kypho, MILD, Discectomy, lots of SCS/PNS trials etc) and significant amount of "OR pain procedures" at a very busy practice seeing 30-40 pts/day - how many of you are commonly performing these procedures and are... private practice concern
This study therefore investigated the impacts of RRCC on air pollution based on detailed household heating data obtained from intensive face-to-face interviews in Shandong province, China. The total contributions and specific contributions of coal, stoves, and coal-stove combinations to air pollution were simulated using the WRF-CAMx-PSAT model. The RRCC for heating had a considerable impact on air pollution, contributing 36.1, 9.1, and 16.1% of atmospheric SO2, NOx, and PM2.5 in winter, respectively. Different coal-stove combinations had different impacts on air pollution and mitigation efficiencies. The combination of bi...
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Mario Gennaro Mazza, Rebecca De Lorenzo, Caterina Conte, Sara Poletti, Benedetta Vai, Irene Bollettini, Elisa Maria Teresa Melloni, Roberto Furlan, Fabio Ciceri, Patrizia Rovere-Querini, COVID-19 BioB Outpatient Clinic Study group, Francesco Benedetti
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Xiaoqin Liu, Trine Munk-Olsen, Clara Albiñana, Bjarni J. Vilhjálmsson, Emil M. Pedersen, Vivi Schlünssen, Marie Bækvad-Hansen, Jonas Bybjerg-Grauholm, Merete Nordentoft, Anders D. Børglum, Thomas Werge, David M. Hougaard, Preben B. Mortensen, Esben Agerbo
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Fernando Lopes, Fernando A. Vicentini, Nina L. Cluny, Alexander J. Mathews, Benjamin H. Lee, Wagdi A. Almishri, Lateece Griffin, William Gonçalves, Vanessa Pinho, Derek M. McKay, Simon A. Hirota, Mark G. Swain, Quentin J. Pittman, Keith A. Sharkey
BEST supplements to relieve joint pain: Is your arthritis playing up? The wetter and colder months could partially be to blame. These two pills may help.