New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?
This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea.BP:143/99, Pulse 109, Temp 37.2 °C (99 °F), Resp (!) 32, SpO2 95%On exam, he was tachypneic and had bibasilar crackles.Here was his ED ECG:There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities.There is a large peaked P-wave in lead II (right atrial enlargement)There is left axis deviation consistent with left anterior fascicular block.There are nonspecific ST-T abnormalities.There is no evidence of infarction or ischemia.Troponin I was 0.054 ng/mLNT-ProBNP was 8316 (0-900 pg/mL)."NT-proBNP values less than 300 pg/ml have a 99% negative predictive value for excluding congestive heart failure. A cutoff of 1200 pg/ml for patients with a normal eGFR is very specific for heart failure. A diagnostic NT-proBNP cutoff of 900 pg/mL has been suggested in adults 50-75 years of age in absence of renal failure. "A bedside POC cardiac ultrasound was done:Findings: Decreased left ventricular systolic function.The patient was given furosemide and admitted to the hospital.Later, he underwent a formal echocardiogram:Very severe left ventricular enlargement (LVED diameter 7.4 cm).Severely decreased left ventricular systolic function with an estimated EF of 20-25%.No left ventricular wall motion abnormality identified.Severe right ventricular enlargement and mildly d...
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]
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
CONCLUSIONS: Considering the low number of university students disclosing sexual assaults to health professionals or support services, the results of this survey suggest more work is needed to facilitate greater disclosures to health professionals enabling victims to access the services they need regardless of alcohol use. PMID: 33032303 [PubMed - in process]
Conclusion: Ambulatory renal and cardio-vascular follow-up in case of neonatal medical history can be enhanced, with necessity to raise awareness and to edict guidelines available to pediatricians.What is Known:•There is a compelling evidence of long-term renal and cardiovascular consequences of prematurity and low birth weight.•Specific cardiovascular and renal follow-up guidelines, coming from professional organizations, are currently not available for these patients.What is New:•Pediatricians in ambulatory setting do not adapt their renal and cardiovascular follow-up in case of neonatal medical history.&b...
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): E.K. Grantham, A.S. Warden, G.S. McCarthy, A. DaCosta, S. Mason, Y. Blednov, R.D. Mayfield, R.A. Harris
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.
Authors: Kim H, Lim YM, Lee EJ, Kim HW, Ahn HS, Kim KK PMID: 33029979 [PubMed]
CONCLUSIONS: More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level. PMID: 33029972 [PubMed]
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