K. Michael Khazalpour

Apremilast Benefits and Risks in PsA Dr. Akhil Sood discusses abstracts 1466, 2583, 0598 and 2640 discussing the use of apremilast in PsA, presented at #ACR24. https://buff.ly/491Nc4b

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Cohort study evaluates changes in the surgeon workforce in health professional shortage areas as a result of the surgeon incentive program. https://ja.ma/40yxJ9Q

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A novel EHR-based population health management using a multi-faceted intervention addressed many implementation barriers to evidence-based CKD care delivery in primary care setting but was not successful in reducing CKD progression. https://ja.ma/3xNkGoM

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RCT: Obstetric Life Support (OBLS) training significantly improved healthcare professionals' cognitive performance, self-efficacy, and ability to manage simulated maternal cardiac arrest events in both hospital and prehospital settings. https://ja.ma/4fvJP8c

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A restricted mean survival time-based analysis provided a clearer clinical meaning to 2 RCTs in progressive multiple sclerosis, which can be used to complement the standard hazard ratio. https://ja.ma/3BvtPV7

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In this study of patients with OHCA, EMS-administered naloxone was associated with clinically significant improvements in return of spontaneous circulation and survival to hospital discharge. https://ja.ma/4fSXfM3

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Meta-analysis: Daily sedation interruption is associated with decreased overall pediatric ICU length of stay with no adverse effects. https://ja.ma/3WAqSJk

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Interesting discussion these days with the rise of Community Acquired Pneumonias & Viral infections every front door during the peak winter months

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Retrospective cohort study finds significant hospital-level variability in GDMT score at HFrEF patient discharge. Higher GDMT score linked to reduced mortality, rehospitalization, and costs, while increasing home time. https://ja.ma/3ZB3QFe

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Postdiagnosis weight gain was associated with an increased risk of HF after breast cancer development, with risk escalating alongside greater weight gain. https://ja.ma/4fQuXk3

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When choosing anti seizure medication..efficacy is important but tolerability is important too. Good doctor identify key points to to evaluate tolerability before starting ASM.

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🚨 ER ECG Case Study #4: What's Your Diagnosis? 🚨 📋 Case Overview: An 82-year-old female presented to the Emergency Room with acute chest pain. Below is the ECG tracing included in the post. Your challenge is to analyze this case systematically and uncover the diagnosis hiding in plain sight. 🩺 🔍 Step into the ER: Chest pain in the elderly is a critical presentation that warrants immediate attention. With her age and symptoms, this case could involve any number of conditions, including: Acute coronary syndromes (ACS) Arrhythmias Structural heart diseases Pulmonary or systemic causes mimicking cardiac pain The ECG is your first clue—what does it reveal? 🛠️ How to Analyze This ECG Here’s a systematic approach to guide your interpretation: 1️⃣ Heart Rate & Rhythm: Is the rate within normal limits? Is the rhythm regular or irregular? 2️⃣ P Wave & PR Interval: Do the P waves precede each QRS complex? Are there conduction delays or blocks? 3️⃣ QRS Complex: Check for width, morphology, and axis deviation. Any signs of bundle branch blocks or hypertrophy? 4️⃣ ST Segment: Look for elevation, depression, or nonspecific changes. Are there patterns suggesting ischemia or infarction? 5️⃣ T Wave & U Wave: Inversions, peaking, or flattening? Prominent U waves could hint at electrolyte imbalances. 📸 Challenge for You: What stands out on this ECG? Could this tracing indicate a life-threatening event, or are the findings more subtle? Consider the patient’s age and symptoms when piecing together your diagnosis. 🧠 Think Critically: This ECG is a puzzle waiting to be solved. Chest pain in an elderly patient can represent a broad spectrum of diagnoses, but time is critical—what's your call? Share your interpretations in the comments below. Let’s see how many of you can pinpoint the abnormalities and identify what’s happening in this case. 📌 Stay tuned for the official answer and discussion in the next post! Don’t forget to tag your colleagues and challenge them to crack this case. Let’s foster learning and collaboration! #ECGCaseStudy #ERCase #CardiologyChallenge #ECGAnalysis #EmergencyMedicine #CardiologyEducation #LinkedInLearning #HeartHealth #Electrocardiogram #MedicalProfessionals

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🩺 ER ECG Case #4: An 82-Year-Old Female with Chest Pain Clinical Interpretation: This case is a striking example of a complex ECG scenario in an elderly patient, emphasizing the challenges of diagnosing acute myocardial infarction (AMI) in the presence of confounding rhythm patterns. Let’s break this down for an educational and professional review: Key Findings on the ECG 1️⃣ Rhythm Analysis: The ECG shows a regular, wide QRS complex rhythm at a rate of 94 beats/min, indicative of accelerated idioventricular rhythm (AIVR). This rhythm originates from the ventricles and often occurs transiently, particularly in settings like myocardial ischemia or reperfusion. 2️⃣ Sinus Bradycardia with AV Dissociation: Alongside the AIVR, sinus bradycardia is present at a slower rate of 56 beats/min. The P waves, sometimes hidden in the QRS complexes, can be traced independently, confirming AV dissociation—a hallmark of ventricular rhythms like AIVR. 3️⃣ LBBB Pattern: The left bundle branch block (LBBB) pattern seen here represents electrical activation originating from the ventricular rhythm rather than a true conduction block. This underscores the importance of differentiating native LBBB from other wide-complex rhythms. 4️⃣ Acute Myocardial Injury: Marked ST-segment elevation in the anterolateral leads is evident, consistent with acute myocardial injury. However, the coexisting LBBB pattern makes localizing the infarction challenging, as it can obscure typical ST-T wave changes. Discussion and Diagnostic Pearls 🔍 Why Does AIVR Occur? AIVR is commonly associated with ischemia or reperfusion in AMI. Its regularity and wide QRS complexes are key distinguishing features. The AV dissociation noted here reflects the intrinsic ventricular rhythm outpacing the sinus rate. 🔍 Challenges in Diagnosing STEMI with LBBB: LBBB patterns make it notoriously difficult to identify STEMI due to baseline ST-T abnormalities. In this case, the anterolateral ST elevation strongly suggests acute myocardial injury, requiring prompt action despite diagnostic complexity. 🔍 Clinical Management Implications: The patient’s presentation of chest pain, AIVR, and ST elevation in the context of LBBB warrants immediate attention. Reperfusion therapy (e.g., PCI) should not be delayed when clinical suspicion of STEMI is high, even if ECG findings are inconclusive. Take-Home Clinical Pearls for Professionals: Accelerated Idioventricular Rhythm (AIVR): Often transient, it is a sign of reperfusion or ischemia. Monitor for progression to more malignant rhythms. STEMI in LBBB: Remember the modified Sgarbossa criteria to assist in identifying infarction in challenging LBBB cases. 🌍 Marked ECG tracing in first comment #ECGCaseStudy #Cardiology #EmergencyMedicine #AcceleratedIdioventricularRhythm #STEMI #MyocardialInfarction #LBBBChallenges #ClinicalReasoning #HeartHealth #MedicalEducation #ReperfusionTherapy #CardiologyCommunity

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Most viewed in the last 7 days from JAMA Neurology: β-blocker use was associated with delayed motor onset in preHD and reduced the rate of worsening of symptoms in mmHD. https://ja.ma/4gNwokn

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