最高の Board Review ポッドキャスト (2025)

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Stop Putting That in Your Eye, Please 44:29

5d ago44:29

44:29

Your Redness Relief Eye Drops Are Lying to You. If I took your bottle of Visine away, it’s because I like you—and I want you to stop putting menthol-laced lies directly onto your corneas. Droopy Eyelid? Might Be Nothing. Might Be Neurology. One eyelid. One confusing pupil. Zero time to guess wrong. This one kept me thinking longer than it should’ve…

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🎙️ Episode 44: Thiazide Throwdown: HCTZ vs Chlorthalidone in Real Life 2:47

26d ago2:47

2:47

Send us a text 🧠 Clinical Context Hydrochlorothiazide (HCTZ) vs. Chlorthalidone—a classic cardio debate! ALHAT once hinted at chlorthalidone’s superiority, but did a modern head-to-head trial confirm that? Let's break it down. 🧪 Study Snapshot: The HEADS-UP Trial Design: Randomized, head-to-head trial Population: ~14,000 patients, age ≥65, already …

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Dr. Mike vs. Anti-Vaxxers: What Went Down on Surrounded? 46:36

10d ago46:36

46:36

I dive into a mix of strange eye conditions, pop culture moments, and one very public showdown between a doctor and a group of anti-vaxxers on Jubilee’s Surrounded. But beyond the headlines, there’s a deeper conversation here—about what it costs to stay online, stay visible, and speak up. You’ll laugh, you’ll cringe, and you might even check your e…

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Real Bone or Fake Bone? Ortho Bro Decides! | Glauc Talk 43:43

16d ago43:43

43:43

we ask a deceptively simple question: Would you let your kid become a doctor? What starts as a heartfelt reflection on medicine, sacrifice, and identity quickly unravels into a chaos-filled ride through policy disasters, parenting hypotheticals, and bone-based controversy. We touch on the NIH budget freeze and massive proposed Medicaid cuts—and why…

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The Poop Question GI Doctors Are Tired of Hearing with Dr. Kaveh Hoda 1:04:24

22d ago1:04:24

1:04:24

we welcome back Dr. Kaveh Hoda—gastroenterologist, musician, podcaster, and accidental poop ambassador. We discuss what life is really like as a GI doc (spoiler: it’s not all about poop), how Match Day can go terribly wrong—or surprisingly right—and why some residents get influenced by... ultimate frisbee. Kaveh also opens up about his path into me…

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🎙️ Episode 42: DOACs Decoded: When to Dabble, When to Dodge 3:22

26d ago3:22

3:22

Send us a text 🧠 Clinical Context DOACs (Direct Oral Anticoagulants) have revolutionized anticoagulation—goodbye routine INRs, hello convenience. But while they’ve made our lives easier, they’re not always a fit for every scenario. Here's how to navigate the DOAC jungle. ✅ When DOACs Are Preferred Venous Thromboembolism (VTE) Atrial Fibrillation ⚠️…

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🎙️ Episode 43: GLP-1s Under the Knife – A Gut Check on Surgery Risks 1:59

26d ago1:59

1:59

Send us a text 🧠 Clinical Context GLP-1 receptor agonists have taken center stage for both type 2 diabetes and obesity management, but their gastric side effects are giving anesthesiologists pause. The ASA's recent guidance recommends holding these agents before surgery to reduce risks of gastroparesis, regurgitation, and pulmonary aspiration. 🔬 AS…

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🎙️ Episode 41: Stairway to Surgery: Cardiac Clues Before the Cut 2:18

26d ago2:18

2:18

Send us a text 🧠 Clinical Context: You're prepping a patient for non-cardiac surgery—what's their cardiovascular risk? Turns out, it’s not always about echo reports or cath results. It starts with a stairs test (sort of). Duke Activity Status Index (DASI) and METs >4 can tell you if the heart's got enough reserve. 🚶‍♂️ “Can you walk up a flight of …

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🎙️ Episode 45: Mind the Gap – Perioperative Pearls for Older Adults 1:39

26d ago1:39

1:39

Send us a text 🧠 Clinical Context Patients over 65 undergoing inpatient surgery face unique risks. Cognitive impairment, frailty, and increased vulnerability to delirium demand a proactive and nuanced approach to anesthesia and postoperative care. 🔍 Preoperative Priorities Age ≥65 and inpatient status should automatically trigger a frailty and cogn…

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🎙️ Episode 4: Migraine Mayhem: Atogepant Enters the Ring 2:11

26d ago2:11

2:11

Send us a text 🧠 Clinical Context: Episodic migraines (<15 days/month) that don’t respond to traditional preventives. Patients often fail beta blockers, AEDs, TCAs, CCBs — need new options. 🧪 Study – RCT on Atogepant: 315 patients, mostly women, who failed ≥2 oral preventives. Randomized to atogepant 60 mg daily vs placebo. Follow-up: 3 months. 📈 O…

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🎙️ Episode 24: Pretreat or Nah? P2Y12s in NSTEMI Under Fire 3:50

26d ago3:50

3:50

Send us a text 🧠 Historical practice: Pre-load clopidogrel (or ticagrelor) before cath. Rationale: reduce thrombotic burden prior to PCI. 🧪 New Data: Large observational study: 100k+ NSTEMI patients. No benefit in MI or death with pretreatment. Longer LOS, delayed CABG in pre-treated patients. 🧩 Clinical Takeaway: Defer P2Y12 until coronary anatomy…

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🎙️ Episode 3: Get an Arm Up: BP Readings That Actually Make Sense 2:56

26d ago2:56

2:56

Send us a text 🧠 Clinical Context: Blood pressure errors due to bad positioning = misdiagnosis and mistreatment. We often blame the drug, when the data was flawed to begin with. 🧪 Study Highlights: 104 patients tested with 3 positions: Hand in lap: BP falsely elevated by 4 mmHg. Arm unsupported: +6 mmHg (most common real-world scenario). Arm suppor…

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🎙️ Episode 33: Spot Check: Urinary Sodium and Diuretic Response 2:46

26d ago2:46

2:46

Send us a text 🧠 Clinical Tool: Spot urine sodium 2 hours after IV loop diuretic. If <50–70 mmol/L → inadequate response. Consider doubling dose or switching loop agents. 💡 Tips: Also assess urine output in first 6 hours (<100–150 mL/hr = poor response). Less helpful after 24 hrs or in chronic diuretic users. 🧩 Clinical Takeaway: Fast, practical gu…

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🎙️ Episode 30: PAD Progress: Low-Dose Rivaroxaban Gets the Green Light 1:48

26d ago1:48

1:48

Send us a text 🧪 VOYAGER-PAD Trial: Patients with PAD post lower extremity revascularization. Rivaroxaban 2.5 mg BID + aspirin vs aspirin alone. 📈 Results: ↓ Major Adverse CV Events (MACE). ↓ Major Adverse Limb Events (MALE). Modest ↑ in bleeding — no ↑ in fatal bleeds. 🧩 Clinical Takeaway: Now guideline-endorsed for symptomatic PAD post-interventi…

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🎙️ Episode 19: Metformin's Stage 4 Surprise – A CKD Curveball 3:06

26d ago3:06

3:06

Send us a text 🧠 Clinical Context We’ve long been taught to stop metformin once GFR drops below 30 due to concerns about lactic acidosis. But what if—just maybe—some patients might actually do better by continuing it? Enter a large-scale Scottish national database review that turned this dogma on its head. 🧪 Study Highlights Design: Retrospective a…

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🎙️ Episode 14: Cool Pads & Hot Brains: Fever Control in Stroke Disappoints 3:39

26d ago3:39

3:39

Send us a text 🧠 Clinical Context Fever is known to be associated with worse neurologic outcomes in stroke, both ischemic and hemorrhagic. Intuitively, preventing fever seems like a slam-dunk goal, right? This study took that theory to trial, literally. 🧪 Study Highlights: The INTREPID Trial Design: Open-label, randomized controlled trial with blin…

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🎙️ Episode 22: Pressure in the Cranium: ICP Demystified 5:15

26d ago5:15

5:15

Send us a text 🧠 Core Concept: Cerebral perfusion pressure (CPP) = MAP – ICP. Normal ICP = ~10 mmHg; threshold for concern >20 mmHg. 🧰 Management Strategies: Elevate head of bed (30°), ensure neck is midline. 3% hypertonic saline preferred over mannitol in AKI. Short-term hyperventilation (↓ PaCO₂ → vasoconstriction). Consider sedation or decompres…

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🎙️ Episode 8: Agitated Minds: Brexpiprazole for Alzheimer’s Agitation 3:01

26d ago3:01

3:01

Send us a text 🧠 Clinical Problem: Behavioral disturbances in Alzheimer’s are notoriously hard to treat. Guidelines tell us: “Don’t use antipsychotics” — but what do you do at 2AM when Nana's throwing punches? 💊 Study Overview: 345 patients, moderate-severe Alzheimer’s + aggressive agitation. Brexpiprazole 2–3 mg daily vs placebo. Dosing didn’t dif…

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🎙️ Episode 16: Iron Deficiency Unplugged: More Than Just Ferritin 6:47

26d ago6:47

6:47

Send us a text 🧠 Hidden epidemic: 50–70% of premenopausal women have iron deficiency. Also common in CKD, GI bleeding, chronic disease. 🔍 Diagnosis Pearls: Ferritin cutoff: <30 ng/mL (not 20!) for iron deficiency. RLS patients: target ferritin >75. Consider retic count: low = underproduction; high = bleeding/hemolysis. 💊 Treatment Tips: Oral iron: …

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🎙️ Episode 38: TXA for ICH: Not the Magic Bullet 2:06

26d ago2:06

2:06

Send us a text 🧪 Study: TXA within 2 hrs of ICH did not reduce hematoma expansion. No benefit in functional outcome or mortality. ⚠️ Note: Slight ↑ in thromboembolic events (3% vs 1%). 🧩 Clinical Takeaway: No routine use for TXA in spontaneous ICH. Still potential niche use in select trauma cases. Please visit www.Brilliantcourses.com to reflect on…

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🎙️ Episode 37: Transfusions in SAH: 8 or 10? Pick 8 2:51

26d ago2:51

2:51

Send us a text 🧠 Study: Compared transfusion thresholds of Hgb <8 vs <10 in subarachnoid hemorrhage. 📊 Findings: No difference in modified Rankin Score at 12 months. Fewer transfusions, fewer complications in <8 group. 🧩 Clinical Takeaway: Restrictive transfusion strategy is safe in neuro ICU. Less exposure = better outcomes. Please visit www.Brill…

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🎙️ Episode 29: Restless Leg SOS: Gabapentin and Friends to the Rescue 3:00

26d ago3:00

3:00

Send us a text 🧠 Problem: RLS causes chronic sleep disruption, often worsens in hospital or peri-op settings. 💊 Management: First-line: Gabapentin or Pregabalin (per American Academy of Sleep Medicine). Avoid long-term dopamine agonists — cause augmentation and impulse control disorders. 🩸 Bonus Tip: Check ferritin — keep it >75 ng/mL. Oral or IV i…

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🎙️ Episode 23: Hot Flash Fix: Fezolinetant Makes Menopause Manageable 1:25

26d ago1:25

1:25

Send us a text 🧠 Problem: 80% of menopausal women suffer from vasomotor symptoms (hot flashes, night sweats). Many can't take hormone therapy (VTE, CAD, breast CA). 💊 Fezolinetant: NK3 receptor antagonist — first in class. Reduces frequency and intensity of hot flashes. Safe in patients who can’t take estrogen. ⚠️ Side Effects: GI symptoms, transam…

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🎙️ Episode 13: Parkinson’s and Levodopa: Early Start, No Regret 2:10

26d ago2:10

2:10

Send us a text 🧠 Clinical Myth: “Delay levodopa to delay motor complications.” 🧪 LEAP Trial (Levodopa in Early Parkinson’s): Compared early start vs 40-week delayed start. 5-year follow-up showed no difference in motor fluctuations or dyskinesia. 📈 Key Outcomes: Early levodopa = better function earlier, no long-term harm. Wearing off effect was sim…

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🎙️ Episode 12: Seven Days or Fourteen? Shorter Wins for Bacteremia 2:54

26d ago2:54

2:54

Send us a text 🧠 Clinical Question: Are we overtreating bloodstream infections with 14-day regimens? 🧪 Study Overview: Multicenter RCT in ICU/inpatient settings (7 vs 14 days of antibiotics). Excluded: Immunosuppressed, endocarditis, Staph aureus, and infections needing longer therapy. 📈 Findings: No difference in 90-day mortality or relapse. More …

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Episode 28: Warfarin & Brain Bleeds: Restarting After Hemorrhage in Mechanical Valves 2:32

26d ago2:32

2:32

Send us a text 🧪 Study: Retrospective look at patients with intracranial hemorrhage (ICH) on warfarin for mechanical valves. Followed for stroke, rebleed, mortality. 📈 Findings: Only 2 strokes in first 7 days after stopping warfarin. Most resumed warfarin around day 7 with low rebleed risk. ⚠️ Exclusions: Massive bleeds, unstable patients, large he…

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🎙️ Episode 35: Tirzepatide Tackles HFpEF and Obesity 2:33

26d ago2:33

2:33

Send us a text 💊 Study: SURMOUNT-HF trial — patients with obesity and HFpEF. Tirzepatide = ↓ HF hospitalizations and ↑ quality of life. 📈 Benefits: Significant weight loss. Better metabolic profiles. GI side effects: ~6% (nausea, diarrhea). 🧩 Clinical Takeaway: A major contender for cardio-metabolic syndrome with HFpEF. More than just a diabetes or…

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🎙️ Episode 20: RSV Shots and Seniors: Who, When, and Why 3:18

27d ago3:18

3:18

Send us a text 🧠 Background: RSV causes significant morbidity/mortality in older adults. Previously considered a pediatric virus only. 📈 Epidemiology: Hospitalization rate: 91/100,000 (ages 64–74). 738/100,000 in assisted living patients. 💉 Vaccine Update: CDC now recommends RSV vaccine for: All ≥75 years old. 60–74 years with chronic conditions (l…

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🎙️ Episode 27: Statin Confusion? Try the PREVENT Calculator 3:33

26d ago3:33

3:33

Send us a text 📊 What It Is: A modern CV risk estimator developed from 2.3 million-person dataset. Replaces outdated ASCVD calculator (based on 25k). 🧠 Features: Adds BMI, GFR, A1C, and zip code. Omits race — more equitable. Outputs risk of heart disease, stroke, heart failure. ⚠️ Caveats: Generally gives lower risk estimates vs ASCVD. May reduce s…

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🎙️ Episode 21: The Nuclear Option: Aztreonam-Avibactam vs MDR Gram-Negs 2:22

26d ago2:22

2:22

Send us a text 🧠 Context: Rising rates of carbapenem-resistant gram-negatives, especially those producing MBLs like NDM, VIM. 💊 Drug Combo: Aztreonam + Avibactam = a lifeline for metallo-beta-lactamase (MBL) producers. FDA-approved for: Complicated intra-abdominal infections (with metronidazole). Hospital-acquired and ventilator-associated pneumoni…

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🎙️ Episode 31: Semaglutide and the Eye: NAION Signal in Sight. 2:16

26d ago2:16

2:16

Send us a text 🧪 Key Insights: Observational data links semaglutide (GLP-1 RA) to increased risk of non-arteritic anterior ischemic optic neuropathy (NAION). Incidence: ~9–15 cases per 100,000 patient-years. Possible mechanism: GLP-1 receptors in optic nerve ganglion cells. No proven causality yet — retrospective study only. 🧩 Clinical Takeaway: Ri…

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🎙️ Episode 9: Mavacamten: Calming the Hyperdynamic Heart 3:00

26d ago3:00

3:00

Send us a text 🧠 Clinical Context: Hypertrophic obstructive cardiomyopathy (HOCM): Genetic disorder causing LVOT obstruction. Traditionally managed with BBs, CCBs, disopyramide… or surgery. 💊 Drug: Mavacamten (Cardiac Myosin Inhibitor) Targets sarcomeric hypercontractility directly. FDA approved for NYHA Class II–III obstructive HCM. 🧪 EXPLORER-HCM…

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🎙️ Episode 6: Statin Intolerant? Say Hello to Bempedoic Acid 2:25

26d ago2:25

2:25

Send us a text 🧠 Clinical Context: For patients who absolutely cannot tolerate statins — despite trying multiple options or experiencing severe side effects. Reminder: Always try multiple statins first (different types, dosages, timing) before declaring “statin intolerance.” 💊 What is Bempedoic Acid? Non-statin oral agent, works upstream of HMG-CoA…

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🎙️ Episode 40: Anticoag After Ischemic Stroke: Sooner May Be Safer 2:00

26d ago2:00

2:00

Send us a text 🧠 Trial: DOAC started at 3 days vs 8–14 days post-stroke in AF patients. 📊 Results: No ↑ bleeding. No ↑ ischemic events. 🧩 Clinical Takeaway: Safe to start within 4 days in mild to moderate stroke. Still tailor based on infarct size and bleeding risk. Please visit www.Brilliantcourses.com to reflect on this activity with Learner+ pla…

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🎙️ Episode 36: Mitral Valve 2.0: Transcatheter Repair Steps Up 3:36

26d ago3:36

3:36

Send us a text 🧪 Trials: RESHAPE-HF2: ↓ HF hospitalizations with transcatheter edge-to-edge repair vs medical therapy. MATTR: Transcatheter approach non-inferior to surgical repair. 🧩 Clinical Takeaway: Game-changing for patients too high risk for surgery. Less peri-op risk, faster recovery — mitral repair is heading the way of TAVR. Please visit w…

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🎙️ Episode 32: SGLT2 vs Kidney Stones: A Surprising Win 3:05

26d ago3:05

3:05

Send us a text 🧪 Key Findings: Cohort study: SGLT2 inhibitors led to significantly lower rates of nephrolithiasis compared to GLP-1 RAs. Mechanism: increased urinary flow and uric acid excretion. 🔢 Stats: NNT = 20 for prevention. NNT = 5 for recurrent stone formers. 🧩 Clinical Takeaway: Another bonus benefit of SGLT2 inhibitors. May sway decision i…

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🎙️ Episode 26: Radiation Optional? Rethinking Esophageal Cancer Pre-Op 2:27

26d ago2:27

2:27

Send us a text 🧪 The EPOC Trial: Compared FLOT chemotherapy alone vs chemo + radiation before surgery in localized esophageal/gastroesophageal adenocarcinoma. 📈 Findings: FLOT alone led to better 3-year progression-free survival: 51.6% vs 35%. No survival benefit from adding radiation. Patients receiving FLOT alone had fewer complications, improved…

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🎙️ Episode 2: Fractures and Fall Risk: When Antihypertensives Tip the Scale 2:54

26d ago2:54

2:54

Send us a text 🧠 Clinical Context: Nursing home residents are fragile fall-prone patients. Starting a new antihypertensive could trigger orthostasis → serious fractures. 🧪 Study – VA Nursing Home Cohort: 13,000+ residents tracked from 2006–2019, mean age ~78. Examined fracture risk 30 days after starting an antihypertensive. Fractures studied: Pelv…

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Episode 11: Breast Surgery, Lightened: The Axillary De-Escalation Revolution. 2:47

26d ago2:47

2:47

Send us a text 🧠 Clinical Context: Historically, breast cancer treatment has included radical mastectomies and full axillary dissections. New data supports less invasive approaches for specific low-risk populations. 🧪 The SOUND Trial (and similar studies): T1–T2 tumors (≤5 cm), clinically node-negative, ER+. Compared no axillary surgery vs sentinel…

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🎙️ Episode 1: Silent A-Fib, Loud Decisions: ARTESIA and the ASA-Apixaban Showdown 3:46

26d ago3:46

3:46

Send us a text 🧠 Clinical Context: Subclinical atrial fibrillation = asymptomatic episodes of AF detected by implantable monitors or Holters, lasting 6 minutes to 24 hours. Big Question: Should we anticoagulate these patients? 🧪 Study Highlights – ARTESiA Trial: Design: 4,012 patients (mean age 76.8), randomized to apixaban 5 mg BID vs ASA 81 mg da…

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🎙️ Episode 18: Fine-tuning HFpEF: Finerenone Finds Its Footing 3:58

26d ago3:58

3:58

Send us a text 🧠 Clinical Problem: HFpEF (Heart Failure with Preserved EF) has lacked effective, proven therapies. Finerenone (non-steroidal MRA) offers new hope. 🧪 FINEARTS-HF Trial: 6,000+ patients with EF ≥40%, followed for ~32 months. Compared Finerenone vs placebo. 📈 Results: ↓ Heart failure hospitalization significantly. No significant reduct…

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🎙️ Episode 5: Beta Blockers Post-MI: To Drop or Not to Drop? 3:23

26d ago3:23

3:23

Send us a text 🧠 Clinical Context: BBs have been MI standard since the thrombolysis era. But do they still help when patients get PCI, statins, and ACEs? 🧪 Two Major Studies: Swedish Registry Study: Post-MI patients with preserved EF. All received PCI + standard meds. BB vs no BB: No difference in death or recurrent MI. French Study (New England Jo…

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🎙️ Episode 15: Fine-tuning HFpEF: Finerenone Finds Its Footing 2:34

26d ago2:34

2:34

Send us a text 🧠 Clinical Problem: HFpEF (Heart Failure with Preserved EF) has lacked effective, proven therapies. Finerenone (non-steroidal MRA) offers new hope. 🧪 FINEARTS-HF Trial: 6,000+ patients with EF ≥40%, followed for ~32 months. Compared Finerenone vs placebo. 📈 Results: ↓ Heart failure hospitalization significantly. No significant reduct…

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🎙️ Episode 25: Methotrexate for OA Pain? Believe It or Not 3:41

26d ago3:41

3:41

Send us a text 🧠 Surprising contender: OA is not just wear-and-tear — there's an inflammatory phenotype. 🧪 Trial: MTX 10–25 mg/week in knee OA with persistent pain. Significant ↓ pain and improved function vs placebo. ⚠️ Side Effects: GI upset, mouth ulcers, fatigue. Hepatotoxicity, myelosuppression, pulmonary fibrosis (rare). Always co-prescribe f…

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🎙️ Episode 7: Transfusion Targets Post-MI: Is 9 the New 10? 1:21

26d ago1:21

1:21

Send us a text 🧠 Clinical Question: What's the optimal hemoglobin threshold for transfusion post-MI? Old dogma: “Keep Hgb >10”. New data: Less might be just as safe. 🧪 The MINT Trial (Myocardial Ischemia & Transfusion): Compared liberal (Hgb <10) vs restrictive (Hgb <8) transfusion strategies. Lower 30-day recurrent MI or cardiac death seen with Hg…

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🎧 Episode: HFpEF Happy Hour – Meds That Make a Difference 5:07

26d ago5:07

5:07

Send us a text 🧠 Clinical Context Heart failure with preserved ejection fraction (HFpEF) typically presents with orthopnea, dyspnea, edema, and often subtle signs like an S3 or elevated JVP—despite a normal EF (>50%). Diagnosing it requires nuance, and ruling out other causes of dyspnea is key. 🧪 Rule Out First Before calling it HFpEF, think differ…

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🎙️ Episode 39: Vitamin K2: The Leg Cramp Secret? 1:30

26d ago1:30

1:30

Send us a text 🧪 Study: Vitamin K2 (180 mcg) reduced nocturnal leg cramps in elderly. 📉 Results: Cramps/week ↓ from 3.6 → ~1 over 8 weeks. Safe and well-tolerated. 🧩 Clinical Takeaway: Consider a K2 trial in patients with chronic cramps — especially if sleep-disrupting. Avoid in patients on warfarin. Please visit www.Brilliantcourses.com to reflect…

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🎙️ Episode 10: Colchicine & Diabetes: The Unsung Hero Post-MI? 1:18

26d ago1:18

1:18

Send us a text 🧠 Clinical Background: Inflammation plays a big role in atherothrombosis. Colchicine — an old gout drug — shows promise in CV risk reduction. 🧪 COLCOT Trial: Colchicine 0.5 mg daily post-MI. Greatest benefit in patients with type 2 diabetes. 📈 Outcomes: Reduced MACE (MI, stroke, death) in diabetics. Adverse Effects: Nausea, diarrhea,…

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🎙️ Episode 34: MS Meds After 55? Time for a Pause ? 1:16

26d ago1:16

1:16

Send us a text 🧪 Study: Patients ≥55 with no relapses in 5 yrs and no new lesions in 3 yrs may stop disease-modifying therapy (DMT). No significant difference in disability progression. 🧩 Clinical Takeaway: De-escalation strategy in stable MS may reduce cost and side effects. Still requires close neurology follow-up. Please visit www.Brilliantcours…

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I Had a Surgical Complication—Here’s How I Dealt With It 44:37

1M ago44:37

44:37

I share one of the more difficult days in the OR—when a routine cataract surgery didn’t go according to plan. I walk through the moment everything shifted, how I kept my cool, and what came after—both technically and emotionally. If you’ve ever wondered what it feels like to be a surgeon in that moment, this episode is a rare, honest window into it…

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