Reade De Leacy

Class I occlusion (right side) and Class II occlusion (left side) Establishing 9 occlusal points of contact (5 functional and stabilizing points in the form of 2 tripods and 4 supporting points for load distribution) with respect to 7 mandibular movements (3 primary, 2 mixed and 2 border movements) following the occlusal compass on the upper first molars. 🐉😊 #united_dragons_of_function #occlusal_compass #dental_occlussion #dieter_schulz #natural_waxingup_technique #natural_and_functional_reconstruction #natural_and_functional_prosthetics #NAT #NFR #NFP

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Great case this week by Niloofar Dehghan on Orthobullets highlighting some of the challenges of distal humerus fractures. Check out the comments and insights from around the world. Join in on the conversation. #meded #orthotrauma

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Question for the #kneereplacement gurus. If someone failed a single stage washout for an acute PJI of a remote TKA due to bacteremia (bacteria is Staph Epi), are you doing a 1.5 or 2-stage and if 2-stage, articulating or static spacer? #jointreplacement #medtech #orthopedicsurgery

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

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TNFi mAbs, JAKi, –IL-17 are protective against Anterior Uveitis (AU) in AxSpA. Metanalysis of 44 RCTs shows AU IR: - TNF mAbs: 4.1 - etanercept 5.4 - IL-17i: 2.8 - JAKi: 1.5 - placebo: 10.8

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Using Power Doppler on Esophageal Varices and Collaterals with Endoscopic Ultrasound (EUS) Overview Power Doppler ultrasound is a useful tool for visualizing blood flow in esophageal varices and collateral vessels. When used with endoscopic ultrasound (EUS), it helps in assessing the varices, collateral circulation, and connections to fundal varices, which is critical for planning therapeutic interventions such as variceal banding. Steps for Using Power Doppler with EUS 1. Preparation: • Ensure the patient is appropriately sedated and positioned for the endoscopic procedure. • Calibrate the EUS machine and Power Doppler settings according to the manufacturer’s guidelines. 2. Endoscopic Ultrasound Examination: • Insert the endoscope and navigate to the esophagus. • Position the EUS probe adjacent to the area of interest (esophageal varices, collaterals, or fundal varices). 3. Activating Power Doppler: • Activate the Power Doppler mode on the EUS machine. • Adjust the settings to achieve a clear visualization of blood flow. Power Doppler provides a more uniform and sensitive detection of blood flow compared to traditional Doppler methods. 4. Identifying Structures: • Look for a uniform broad white line, which indicates blood flow. This feature is particularly helpful for beginners in identifying the varices and collaterals. • Carefully scan the esophageal varices to assess their size, location, and blood flow patterns. 5. Assessing Collaterals: • Evaluate the collateral vessels around the esophagus and their connections to fundal varices. • Assess the flow in penetrating vessels to understand the extent of the varices and the collateral circulation. 6. Planning for Banding: • Use the information from the Power Doppler to plan the precise application of variceal bands. • Identifying the exact location and flow dynamics of the varices and collaterals helps in achieving better outcomes with banding. 7. Documenting Findings: • Record images and videos of the Power Doppler findings for further analysis and documentation. • Note any significant findings that could affect the treatment plan, such as large collateral vessels or high flow varices. 8. Performing Banding: • Based on the Power Doppler assessment, carefully proceed with variceal banding. • Ensure precision in band placement to effectively control the varices and minimize the risk of rebleeding. Benefits of Using Power Doppler with EUS • Enhanced Visualization: Power Doppler provides a more detailed and sensitive visualization of blood flow, making it easier to identify and assess varices and collaterals. • Improved Accuracy: By clearly delineating the blood vessels, Power Doppler aids in precise planning and application of variceal bands. • Better Outcomes: Accurate assessment and precise banding can lead to improved patient outcomes by effectively managing variceal bleeding and reducing recurrence.

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Complex Case series #2 LM intervention in ACS and cardiogenic shock #ACS #Cardiogenic shock #youngMI #LM intervention #IABP

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40s y/o remote hx of #hemorrhage as a teenager, he of seizures p/w headaches after exposure to fire in a kitchen. Angio showing what appears to be chronic venous congestion. A case of #venous #Moyamoya? Near total loss of deep venous drainage. #cerebrovascular #neurosurgery #neuroIR #neuroendovascular

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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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#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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Our recent work on relation between conventional echocardiographic parameters and 3DE-derived EF in the detection of RV systolic dysfunction and its association with outcomes has now been published in JASE. When 3DE is not available or feasible, how do we choose which RV parameter to rely on? We have demonstrated that impaired values of FWLS show the closest association with the 3DE-derived RVEF cutoff. The outcomes are the worst if at least 2 conventional echo parameters of RV function are impaired and gradually better if only one or none of them are impaired. Attila Kovács Máté Tolvaj Denisa Muraru Luigi Badano https://lnkd.in/exauCnpq

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It's hard to believe it's been nearly 2 years since our original research article, "Routine Application of Lung Ultrasonography (LUS) in Respiratory Care: Knowledge, Perceptions, and Barriers to Instigate," was published. As we take a moment to look back, the transformation in awareness surrounding #LUS among #RespiratoryTherapists (#RTs) has been nothing short of remarkable. The landscape has shifted significantly. What was once a niche topic has now become a focal point in the field. It's heartening to witness how every RT #conferences now features talks and workshops dedicated to LUS. RTs in clinics are not just discussing its potential but actively integrating it into their practices. Moreover, regulatory bodies are acknowledging its importance by incorporating it into the scope of practice. This quantum leap in awareness is a testament to the dedication and passion of our community. It reflects the collective effort to embrace #innovation and enhance patient #care. However, this journey is far from over. As we continue to move forward, let's remain committed to extracting more value from this experience and the lessons we've learned. Here's to the future, where we anticipate even greater advancements and broader adoption of LUS in #respiratory care. Together, let's pave the way for a healthier and more informed tomorrow. Read from the journal: https://lnkd.in/dcXjFyNs University of Doha for Science & Technology #LungUltrasonography #RespiratoryCare #Innovation #PatientCare #CommunityEffort WINFOCUS WORLD National Board for Respiratory Care - NBRC CSRT - Canadian Society of Respiratory Therapists American Association for Respiratory Care (AARC) Indian Association of Respiratory Care (IARC) Hamad Medical Corporation Sidra Medicine Qatar Research, Development and Innovation (QRDI) Council

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https://lnkd.in/e4ifsXEH Good to see our paper out showing Laparoscopic retroperitoneal para-aortic lymphadenectomy is an acceptable procedure which can guide radiotherapy treatment in women with locally advanced cervical cancer.

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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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So, how has Spine_Endo changed our decision making, cost containment, and exactly who are the winners and loosers here? Case: 67F physician. Gait and sphincter dysfunction from progressive T10/11 cord compression….. 5 years ago, I would have made a midline cut, “standard” decompression, then screws / graft for fusion. Now? Simple = unilateral uniportal decompression. No hardware. D/C 11 hours post op. Winners & Loosers?? Winner 🥇 = The Patient. Looser #1 = The Surgeon = I get paid less :( Looser #2 = The Hospital = get paid less :( Looser #3 = The Company = no hardware :( Don’t get me wrong, I still love my hardware, but endo has changed my practice profoundly. My fusion rates have dropped considerably. On the topic of costs, I keep hearing that “endo costs more”. What total and utter rubbish!! Let me be plain and simple = less fusion + less hospital stay + rapid return to full activity + less complication profile + less follow up costs + less PT = less cost!! I challenege anyone out there to convince me otherwise. I am collecting data to confirm this, but may take me another 18+ months to get there…. Thanks to Dr Chris Huang and Dr Jo Reidy for helping out with this case :) #spineendo #elliquence #neurospineclinic #matrixendoscopy #princeofwalesprivate #myelopathy #thoracic

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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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