The Largest
Global
Physicians-Only
Community

I'm requesting crowd-sourced help with a mystery to satisfy my personal curiosity.  Do readers with relevant expertise believe this skeletal fragment is human?  Neither the photo nor the specimen is mine and I have no further information about the physical characteristics of the specimen.  It appeared on another website I follow but I don't want to give any details that might bias opinions from what is admittedly not very much to go on.  All I'll say is it is claimed to be human of archeological or historical interest and does not imply recent criminal activity.  No scaling data is provided other than what you can impute from the teeth.

I'll follow up in a week or so with the provenance of the specimen and the attribution of the photo, such as I know them.

Thanks for your attention.

A 65-year-old female patient was scheduled for an elective bilateral breast reduction surgery due to chronic back pain and hypertrophic and ptotic breasts. She had a past medical history of smoking; hypertension; hypercholesterolemia; cervical disc protrusions at C2/C3, C5/C6, and C6/C7; intervertebral thoracic disc herniation at T7/T8 and protrusions from T8 to T12; mild lumbar protrusions at L3/L4 and L4/L5; and disc herniation at L5/S1. These disc abnormalities had restrained the patient’s movement for the past 2 years, and she was confined to a wheelchair. She also suffered from left-sided de Quervain’s tendinitis and gastric ulceration.

Surgery was performed under general anesthesia. A total of 150 ml of a local anesthetic combined with adrenaline was injected on each side, and the bilateral procedure was continued using the inverted T-pattern. The total amount of reduced breast tissue, including liposuction, comprised 320 g on the right side (47% fat) and 392 g on the left side (38.3% fat). At the end of surgery, a 12-ch Redon drain was placed on each side. She was uneventfully extubated and moved into the recovery room.

Postoperatively, she experienced acute shortness of breath at rest with a drop in oxygen saturation.

What is the most probable complication that has occurred and how could it be managed? 

©

66 yo male with ischemic stroke was sent to us for TTE , carotid Duplex scan and 24 hs holter monitoring. Attached the ECG and a 4 chambers view Echocardiogram. 

43-year-old woman with no known history of CAD was presented to our hospital’s cardiology clinic with a six-hour history of severe central chest pain and dyspnea.She does not have any known traditional CAD risk factors, arrhythmias, and was haemodynamically relatively stable at the time of admission.Cardiac auscultation revealed a grade 2-3/6 systolic murmur that was the loudest at the apex (fifth left intercostal space, midclavicular line). Lungs were clear to auscultation.Electrocardiography demonstrated sinus tachycardia (105/beats/minute) and ST-segment depression of approximately 3 mm in leads V1 to V6.Her cardiac markers were elevated (troponin I: 14.6 ng/L; normal range: 0.0–0.01 ng/L and creatinine kinase-MB mass: 53.9 ng/mL; normal range: 0.0–3.6 ng/mL)What's the diagnose? Thank you. 

During the outbreak of acute pediatric hepatitis, two centers reported a threefold increase in cases. In their report, the hepatitis was preceded by an acute viral infection with a period of fasting. Patients ranged in age from 3 months to 5 years. One notable finding was that all patients had received acetaminophen therapeutically at least two days before onset. Despite receiving normal doses, the authors asserted that “the potential for this injury may have been augmented by ingestion of therapeutic doses of acetaminophen while patients were in a fasted state”. One might be surprised to learn that this was not a report from the well-known outbreak of acute pediatric hepatitis that occurred in the winter and spring of 2021–2022, but an outbreak that was reported 30 years earlier.

Considering that acetaminophen was the most common drug used in the two largest outbreaks reported currently (UK and USA), we should at least do more than assume it was not a factor. Despite being one of the most common causes of pediatric hepatitis, acetaminophen was never ruled out in this outbreak of acute hepatitis. 

International outbreak of acute pediatric hepatitis: Was acetaminophen the missing link?

A 31 year old female with a history of allergies and asthma presents to your clinic with 2 months of nasal fullness and difficulty breathing but is otherwise healthy. Daily medications include ICS+LABA for asthma, fexofenadine, intranasal fluticasone and xylometazoline for  allergies. She denies other symptoms like fever, coughing or GI symptoms. She does not smoke or drink alcohol. She has had no recent travel or exposure to animals.  As part of the expanded workup she underwent a CT of her maxillary sinuses (which unfortunately was partially cut off) :

The AMA report on a 10-year trend in physician payment methods reveals a significant shift towards dual compensation models, with an increasing number of physicians receiving both salaries and bonuses. In 2022, 68.2% of physicians received some compensation from salary, up from 60.2% in 2012. The percentage of physicians receiving bonuses rose from 27.1% to 38.2%. This trend reflects a move away from single-source payment methods, influenced by the shift from practice ownership to employment and a broader adoption of mixed compensation strategies...Read more. 

How do you anticipate this compensation shift affecting the practice of medicine? Do you believe these trends will affect specialty distribution among newly graduated doctors? 

American Medical Association 

Greetings, I am sending the case of a 60-year-old male, with no significant history, delay in vaccination schedules according to his age. The condition began after "taking care of a family member and getting wet in the rain", he reported pain in the precordial region, as well as asthenia, on physical examination without apparent alterations, analgesic treatment was given. He went for reassessment the next day when he thought about insect bites. Upon examination, 2 erythematous lesions were found in the axillary region and one of them with localized vesicles. What could be an option for pain management, from your experience and the suggestion of applying vaccines from how many days and in this case, general studies were requested to assess immunodeficiency.

Hello, I am interested in developing my career as a medical expert witness. I am thinking of doing it part-time to add something different to my clinical job. Is this possible to do part-time? How is the pay? What certifications do I need? It would be great if someone who has worked in this area could share their expreience. If someone just did a course as a hobby, I would love to also hear about it so I can try it out. Thank you.

BACKGROUND: The aim of this study was to survey the knowledge and treatment management practices for single-sided deafness (SSD) among  different subspecialties of otolaryngology.

METHODS: A questionnaire was sent via Google Sheets to members of the Turkish and Egyptian Otorhinolaryngology Societies between December 2021 and February 2022. For the statistical analysis, the respondents were divided into 3 groups as otologists, non-otologists, and residents at the department of otolaryngology—head and neck department.

RESULTS: There were no statistically significant differences between otologists and non-otologists in radiological imaging (child P = .469, adult P = .140) and preferred treatment method (child P = .546, adult P = .106). However, otolaryngologists showed significant differences in radiological evaluation (P < .001), vestibular evaluation (P = .000), and frequency of treatment options recommended for pediatric and adult SSD patients (P = .000).

CONCLUSION: There were no significant differences in SSD diagnosis, treatment, and rehabilitation between otologists and non-otologists. However, when comparing pediatric and adult patients, there was a difference in the treatment management of SSD patients.

Türe N, İncesulu A, Eldin Mostafa B. Do Otologists and Other Otolaryngologists Manage Single-Sided Deafness Differently? J Int Adv Otol. 2024 Mar 1;20(2):127–34. doi: 10.5152/iao.2024.231140. PMCID: PMC11114245.

A 59 year old woman presents to the emergency department after a witnessed seizure at work. She has no history of seizures. Bloodwork is pending but results of 12 lead ECG are as follows:

 A 37-year-old male with a history of anxiety, COPD, diabetes, hyperlipidemia, hypertension, major depressive disorder, polysubstance abuse, and thyroid disease and obesity who was brought to the ED from a correctional facility with dysphagia and slurred speech. Additional symptoms included left-sided headache, and on physical exam he had restricted extraocular movements. He had recently lost over 70 lbs while taking semaglutide, causing nausea and emesis. Other home medications included albuterol, escitalopram 10 mg, fluticasone-salmeterol, folic acid 1 mg, indomethacin 25 mg, levothyroxine 75 mcg, lisinopril 20 mg, and semaglutide 2 mg.   

©

 After ruling out intracranial/neurovascular etiologies, what should be the next step in the management of this patient?  

60 years old female ,complained of sudden onset chest pain , she was subjected  to coronary angiogram.

What is the best management option, surgery or  coronary stent ?

G-Med has conducted poll exclusively for physicians to gain insight into physician satisfaction with their current income. The poll included 336 physicians who were asked whether they believed they were being paid what they're worth. According to the results, over 50% of physicians did not feel that they were being paid what they deserved, with only 20% stating that they were content with their current income. Additionally, 20% of the respondents believed they could earn more if they worked in a different country, which could indicate that there are significant pay disparities in different regions of the world. Moreover, 4% of physicians reported that they earned more before the COVID-19 pandemic, which suggests that the pandemic may have had an adverse impact on physicians' salaries.

It is crucial to acknowledge the importance of fair compensation for physicians' dedication and expertise. These results reveal that there is a significant proportion of physicians who do not feel adequately compensated for their work. This could have implications for physician recruitment and retention, as well as patient care quality. It is vital for healthcare organizations and policymakers to address the issue of physician pay and ensure that physicians are fairly compensated for their contributions.

With a worsening doctor shortage, with more than half of med school applicants being rejected from medical school. Dr. Jesse M. Ehrenfeld, president of the American Medical Association, highlighted this crisis, noting the severe impact on rural communities and medical education. The demand for physicians is projected to rise significantly by 2034, but simply increasing medical school admissions, which has been happening significantly in the past 22 years, is not enough due to limited clinical training sites and faculty. Experts emphasize the need for more residency programs and teaching doctors, as well as innovative solutions like those implemented by Texas A&M's Rural and Community Health Institute, to effectively address the shortage and improve healthcare access.

Regardless of where you practice medicine (in the US or not), please weigh in in the comments about how the doctor shortage has effected your practice... Read More

U.S. News

Do reports like this make you anxious about the future of healthcare?What do you think we can do to most effectively address this issue?