Fady Charbel

#MS_Selfie Q&A 32 - Is primary progressive MS different to relapse-onset MS? Is PPMS pure smouldering MS? Is the pathophysiology of PPMS the same as SPMS? Why is the spinal cord involved in PPMS? In this podcast I challenge the dogma =>

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Introduction: Gynecology ultrasound stands at the forefront of women's health, offering invaluable insights into the reproductive system and aiding in the diagnosis and management of various gynecological conditions. Behind every successful gynecological ultrasound lies a set of standards that ensure accuracy, safety, and optimal patient care. In this article, we explore the standards governing gynecology ultrasound, highlighting their significance in advancing women's health. Understanding Gynecology Ultrasound: Gynecology ultrasound, also known as pelvic ultrasound, utilizes sound waves to create images of the female reproductive organs, including the uterus, ovaries, and fallopian tubes. These images provide critical information for diagnosing conditions such as ovarian cysts, uterine fibroids, and endometriosis, among others. Gynecology ultrasound plays a pivotal role in both preventive care and the management of gynecological disorders. The Role of Standards: Standards in gynecology ultrasound are essential for maintaining consistency, quality, and safety in clinical practice. These standards are established and upheld by professional organizations such as the American Institute of Ultrasound in Medicine (AIUM) and the Society of Radiologists in Ultrasound (SRU), among others. Key Components of Gynecology Ultrasound Standards: 1. Equipment Requirements: Standards specify the type of ultrasound equipment required for gynecological scans, including high-frequency transducers optimized for imaging pelvic structures with precision and clarity. 2. Training and Certification: Healthcare professionals performing gynecology ultrasound must undergo specialized training and certification to ensure proficiency in image acquisition, interpretation, and patient care. 3. Protocol Guidelines: Standards outline protocols for different types of gynecological scans, such as transabdominal and transvaginal ultrasound, specifying the anatomical structures to evaluate and the measurements to obtain. 4. Safety Measures: Adherence to safety guidelines is paramount to minimize the potential risks associated with ultrasound exposure, ensuring the well-being of patients undergoing gynecology ultrasound examinations. Benefits of Adhering to Standards: 1. Accurate Diagnosis: Following standardized protocols enables healthcare providers to obtain accurate images and measurements, facilitating the diagnosis and characterization of gynecological conditions with precision. 2. Consistent Practice: Consistent application of standards ensures uniformity in gynecology ultrasound practices across different healthcare settings, enhancing the quality and reliability of patient care. 3. Patient Safety: Adherence to safety guidelines protects patients from unnecessary exposure to ultrasound energy, minimizing the risk of adverse effects and ensuring their safety and well-being. #WomensHealth #GynecologyUltrasound #ReproductiveHealth #MedicalImaging #MedicalTraining

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The next pages of this document show how one #DailyCDM question addresses the highlighted parts in the #MCCQE1 objective below. #meded #mccqe #mcc #nac

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Infographic of the Day: "Motor Evoked Potentials (#MEP)" Marisa Desai, one of my neuroscience students at The University of Texas at Dallas, created this infographic. #neuromonitoring #neurophysiology #neuroscience #surgery #patientcare #education #motor #TCeMEP #COMEP #evokedpotential #IONM

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Study of 187 Oligoarticular JIA pts - Remission was achieved w/ DMARDs in 65.8%; predictors of nonresponse (DMARD resistance) - Elevated CRP (> 1.1 mg/dL' OR 1.3) & and high JADAS-71 at Dx (> 15.8; OR 1.7)

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The KetaBAN Trial: Nebulized Ketamine for Pain https://lnkd.in/g_Cp79Sq #REBELEM #Ketamine #Analgesia #MedEd

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Unidirectional conductivity of a diode!!!!!!

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Of 375 #Gout pts D/C pegloticase after a median of 8 infusions (taken 112days (max 1,240d). Only 73% had SUA < 6 during pegloticase. After D/C 84% went on ULT (63% allopurinol; 34% febuxostat; after mean 92d); after ≥ 30 days), 51% achieved SUA < 6

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Limb girdle muscular dystrophy (LGMD): - Autosomal inherited disorder either AD or AR . - New classification introduced in 2017 to be LGMD -D for Autosomal dominant and LGMD- R for Autosomal recessive. - D.D is wide but still having independent walking and proximal weakness is essential for diagnosis. - clinical, CPK level, muscle biopsy and genetic testing are the way for accurate diagnosis. - Genetic defect in muscle tissue or membrane proteins or enzymes is the main etiology. - until now no curative treatment but a gene therapy clinical trial is ongoing now for LGMD- sarcogylycanopathies. @LGMD

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Background: This study compares patients’ satisfaction with patient-controlled analgesia versus intrathecal opioid injection after cesarean section in Shariati and Khalij Fars hospitals in Bandar Abbas City, Iran, from 2016 to 2017.  Methods: This double-blind, randomized clinical trial included 60 women with term pregnancies scheduled for elective cesarean section in Shariati and Khalij Fars hospitals in Bandar Abbas City, Iran, from 2017 to 2018. The patients were randomized into two groups: One group received patient-controlled analgesia (PCA), and the other group received intrathecal opioid injection. A numerical rating scale was used to assess pain and patient satisfaction. The patients also reported nausea, vomiting, and pruritus. The data were analyzed using the SPSS software, version 25.  Results: Nausea and or vomiting did not differ significantly between the groups (P=0.46). The highest frequency of pruritus was observed in the PCA group at 1 (P=0.44), 4 (P=1.00), and 24 (P=0.24) h after surgery. Patient satisfaction was higher in the intrathecal opioid group (9.23±1.22) compared to the PCA group (8.84±1.22); however, the difference between groups was not statistically significant (P=0.08).  Discussion: The results of the current study showed that despite the novelty of PCA, this method is not superior to conventional methods such as intrathecal opioid injection for pain relief. Also, patient satisfaction was lower with PCA compared to intrathecal opioids. #CesareanSection, #PatientControlledAnalgesia, #IntrathecalInjection

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MR-guided Radiation Therapy (MRgRT) is a cutting-edge cancer treatment that combines magnetic resonance imaging (MRI) with radiation therapy to precisely target tumors. This approach offers several advantages over traditional radiation therapy:Enhanced Imaging: MRI provides superior soft tissue contrast compared to other imaging modalities like CT scans, allowing for better visualization of tumors and surrounding healthy tissues.Real-Time Monitoring: MRgRT enables real-time monitoring of the tumor and surrounding organs during treatment. This allows for adjustments to be made on-the-fly, ensuring accurate targeting and minimizing damage to healthy tissues.Adaptive Therapy: The ability to see the tumor and surrounding anatomy in real-time allows clinicians to adapt the radiation dose and targeting based on daily changes in the patient’s anatomy. This ensures the radiation is delivered precisely where it is needed, increasing the effectiveness of the treatment and reducing side effects.Improved Outcomes: By increasing the accuracy of radiation delivery, MRgRT has the potential to improve treatment outcomes, reduce side effects, and enhance the overall quality of life for patients.MRgRT is particularly beneficial for treating tumors in areas that move with breathing or other bodily functions, such as lung, liver, and prostate cancers. The integration of MRI with radiation therapy represents a significant advancement in cancer treatment, offering a more precise, adaptive, and effective approach to radiation therapy.

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New Post: Artificial intelligence in echocardiography is here and more to come

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CARTO Version 8 Features: 1. Several have pointed out AI-influenced, auto-segmental cohesion that creates LA geometry resembling a CT scan, eliminating the need for operator input. 2. The system estimates respiratory excursion and subtracts the actual catheter displacement. An additional point will only be given if the shift exceeds the respiratory excursion. 3. The enhanced COHERENT module allows conduction velocity displays as streaks. While the technical details are unavailable online, the principles are probably the following: - Geodesic principles using Minimal Activation Distance - Multiple unit triangle reconstruction based on LAT - LAT specificity using a refined unipolar electrogram with noise filtration - Right of Fit method for the most plausible activation sequence and appropriate local activation time, allowing Conduction Velocity (CV) mapping. 4. While the technical improvements minimize the need for the operator to have extensive knowledge of electrophysiology principles, there are limitations. 5. This septal flutter had a full cycle length in both atria, and the module predicted the right atrium, while entrainment suggested the left atrium. Mapping the left atrium provided clarity to the module. We still need to understand electrophysiological principles rather than entirely rely on technology.

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Tenapanor as Therapy for Hyperphosphatemia in Maintenance Dialysis Patients: Results from the OPTIMIZE Study This study shows tenapanor as monotherapy or in combination with PBs effectively lowered serum phosphate toward the target range Kidney360 5(5):p 732-742, May 2024 DOI: 10.34067/KID.0000000000000387

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𝐎𝐫𝐨𝐩𝐡𝐚𝐫𝐲𝐧𝐠𝐞𝐚𝐥 𝐂𝐚𝐧𝐜𝐞𝐫: 𝐏𝐫𝐨𝐬𝐩𝐞𝐜𝐭𝐢𝐯𝐞 𝐨𝐟 𝐚 𝐒𝐩𝐞𝐞𝐜𝐡 𝐚𝐧𝐝 𝐒𝐰𝐚𝐥𝐥𝐨𝐰𝐢𝐧𝐠 𝐓𝐡𝐞𝐫𝐚𝐩𝐢𝐬𝐭 👉The oropharynx consists of the structures in the back of the throat, including the base of the tongue, palatine tonsils, posterior pharyngeal wall and soft palate , Uvula , any carcinoma developed in this region is called an Oropharyngeal Cancer. 👉Common symptoms- 📌A sore throat and throat pain that doesn’t get better over time 📌Difficulty in opening the mouth fully 📌Difficulty in moving the tongue 📌Weight loss for no reason 📌Ear pain 📌A lump in the back of the mouth, throat or neck 📌A white patch on the tongue or in the mouth that doesn’t go away 📌Coughing up blood 📌Difficulty or pain with swallowing 📌Muffled voice 📌Neck mass_ A painless swelling or lump in the neck – this is the most common symptom 📌Bad breath 📌Un equal looking tonsils 👉Treatment Option - It mainly depends on extent and location of disease, primary preference is often Non surgical treatment for Oropharyngeal Cancer. ⚡Radical Radiotherapy: In most cases. External beam RT+/- Brachytherapy. ⚡Surgery: (Only if low peri-op risk & reasonable functional outcome) Composite resection + appropriate neck dissection + Adjuvant therapy 👉Expected Swallowing difficulties or Impaired Swallowing Physiology - 📌Reduced BOT retraction causing poor Epiglottic Inversion and risk of penetration and Aspiration 📌Poor Pharyngeal Contraction, Swallowing outcomes has shown significant reduction in that Impaired pharyngeal stripping wave 📌Reduced sensation in Oropharyngeal region due to tumor or treatment modalities can cause Delay in Swallow initiation and pre mature spillage and causing significant risk of penetration and aspiration. 📌Coughing or Choking: Particularly when eating or drinking, due to aspiration (food or liquid entering the airway). 📌Sensation of Food Sticking: Feeling as though food is stuck in the throat or chest due to loss in sensation in oro pharyngeal region. 📌Severe Odynophagia /Pain and Burning sensation while Swallowing:this can result from tumor presence or treatment side effects like RT induced 📌Weight Loss and Malnutrition: Due to the difficulty and discomfort of eating, leading to reduced food intake 📌Voice Changes: To some extent Hoarseness or other changes can occur if the cancer affects the supraglottic or nearby nerves, how very common symptoms, During RT voice change can occur. 📌Nasal Regurgitation is another form of common difficulty reported in Oropharyngeal Cancer where tumor epicentre is mainly at the soft palate region . 📌Hyper/ Hypo nasal voice is also another form of speech related symptoms in Oropharyngeal Cancer .

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USMLE STEP 1 High-Yield Concepts for Cardiology . ➡️ Get USMLE Tutoring: https://lnkd.in/dHVwfxK8 . . #usmle #step1 #studytips #highyield #cardiology #usmleprep #pass #fail #passfail #usmlepassfail

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Practical simulator tests to learn perineal repair surgery

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