I love Grey's Anatomy but we must call time of death inews
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I love Grey's Anatomy but we must call time of death - inews
What Exactly Is an Anesthesia ‘Cocktail’? – Medpage Today
Anesthesiology resident Max Feinstein, MD, discusses common medications used in anesthesia and their effects.
Following is a transcript:
Feinstein: Anesthesiologists sometimes tell patients that they are getting a "cocktail" of medications prior to their procedure, which can sound mysterious and intriguing, when in reality this cocktail is typically just comprised of a single medication called midazolam.
My name is Max Feinstein and I'm an anesthesiologist filming here at the Mount Sinai Hospital in New York City and in this video I demystify the medications that are administered to patients prior to procedures. If you find this video interesting or helpful, I'd really appreciate it if you liked it and subscribe to the channel. Let's dive in.
Before we get too far, just a quick reminder that this video does not contain medical advice; it's just a YouTube video. If you need medical advice, you should talk to your doctor.
Midazolam has several very important properties, which are why anesthesiologists use it. The first of those properties is anxiolysis, which is just a way of saying that it can reduce a person's anxiety. This is, of course, very helpful coming into the operating room if a person is nervous about getting surgery, which is very often the case for understandable reasons.
Another useful property of midazolam is that it can cause anterograde amnesia, meaning that patients won't remember anything after they have received the medication. There is an important distinction between anterograde amnesia, which means not remembering something after the medication has been administered, versus retrograde amnesia, which means not remembering something prior to the medication being administered. Midazolam only causes anterograde amnesia, and even then it doesn't necessarily cause amnesia in all patients. It can depend on the dose of medication that's given as well as patient factors like how much they weigh and whether they consume alcohol, which can have cross-tolerance with midazolam.
Midazolam can be used as a primary anesthetic in cases of light or moderate sedation where the goal is to have the patient still conscious and breathing on their own, but just very relaxed. Midazolam is also used frequently as a precursor to general anesthesia where a patient is completely unconscious and not aware of anything that's going on at all. The amount of midazolam that would need to be administered to produce a depth of general anesthesia is impractical in most cases, and so for that reason when patients do receive general anesthesia, there are other agents that are used such as propofol and sevoflurane.
In a small number of cases, there are other medications that can be administered either in lieu of or in conjunction with midazolam. One of those medications that anesthesiologists sometimes reach for is an opioid called fentanyl, which is also short-acting. Generally speaking, anesthesiologists like to reach for short-acting medications because that can help us maintain fine control over physiologic parameters like heart rate, blood pressure, and respiratory status.
When we do include fentanyl as part of the anesthesia cocktail, that's typically because the patient might be in pain and that might be the reason that they are coming in for surgery, for example, if they broke a bone. Anesthesiologists do have to use caution when mixing midazolam with opioids because together those can cause significant amount of respiratory suppression. If the plan is for the patient to undergo general anesthesia, where they're going to be intubated and mechanically ventilated, then respiratory suppression is kind of a moot point, but it is very important for patients to be able to breathe on their own in the time period immediately prior to undergoing general anesthesia.
Another medication that can be used as part of the anesthesia cocktail is a very low dose of propofol, which when given in 10 or 20 mg increments, won't produce general anesthesia in an adult but will actually just produce anxiolysis and perhaps a bit of amnesia. Having said that, propofol can irritate the vein where it's injected, which can be a reason to avoid giving more propofol to an awake patient than they need.
When I mentioned that midazolam is fast-acting, I mean onset can be 2 minutes or less when given through the IV. It typically won't last for more than an hour, although again that also varies depending on the patient. For adult patients, midazolam is typically administered through an IV, which is placed of course while the patient is completely awake. But for pediatric patients who won't tolerate having an IV placed while they are awake, then we can actually administer an oral form of midazolam, but it has a longer time of onset closer to around 20 minutes or so, again depending on the dose and the patient.
One of the common misconceptions around the anesthesia cocktail is that it's a sort of truth serum that causes patients to just blurt out their deepest darkest secrets. In reality, midazolam typically just causes patients to feel relaxed, chill out, maybe giggle a little bit about things that otherwise aren't that funny, and only extremely rarely do patients become disinhibited enough to start saying things that perhaps they wouldn't have said prior to receiving midazolam.
David: I... I feel funny. Is this going to be forever?
Feinstein: But honestly, I have never had a patient actually disclose anything really that embarrassing while they have been under the effects of midazolam or any other anesthetic agent. It's pretty uncommon.
I mentioned that some patients don't remember much, or anything, after they receive midazolam and I think it's really important for anesthesiologists to make patients understand that that may or may not happen once the medication goes in. Expectation setting is a really important part of the patient experience after all.
By the same token, I think it's very important for anesthesiologists to tell patients when they are receiving midazolam or any other medication that's going to change the way that they feel. I don't think it's really fair to surprise patients with medications through their IV without first telling them that they are about to get something that will change the way they feel. While the vast majority of patients who receive midazolam will feel pretty chilled out, there is a small proportion of patients who have what's called a paradoxical reaction where they become hyper-energetic after receiving the medication.
David's Dad: Stay in your seat.
David: [OUTBURST]
Feinstein: If you're a patient watching this video and you're wondering will you receive midazolam or any other medication as part of the anesthesia cocktail before your procedure, the answer is it depends.
Certain aspects of anesthesia practice can vary pretty considerably depending on factors like who your anesthesiologist is, what procedure you're coming in for, what medications and monitoring are available for patients prior to going into the operating room, and so forth. For these reasons, it wouldn't be surprising to me to know that a patient who is coming in for, say, a laparoscopic appendectomy at a certain hospital would probably not be offered midazolam unless there were extenuating circumstances. Whereas a different hospital that has different practice norms would routinely offer midazolam to patients who are coming in for the same procedure.
I do think this variation in practice begs an important philosophical question about the involvement that patients have with regard to the specific medications that they get for their anesthesia and also the extent to which anesthesiologists are involving patients in the decision about what medications will be administered.
On the one hand, I think there is a lot of benefit for anesthesiologists and their patients to have an open conversation about what medications will be administered and why, but then on the other hand that's also not entirely feasible, especially if a patient is under general anesthesia. And there is also an argument to be made for the fact that it can be overwhelming for patients to have to make medical decisions about the specifics of exactly what they are receiving as part of their anesthetic plan that might overall make the experience more anxiety-inducing than it needs to be, as opposed to simply leaving the decisions to the anesthesiologist about how best to produce the outcome that the patient desires, for example, feeling relaxed or being completely unconscious for a procedure.
If you are a patient and you do have any questions or concerns about any part of your anesthesia plan, then it's important to bring it up with your own physician before you undergo your procedure.
Max Feinstein, MD, is a PGY-4 anesthesiology resident at the Mount Sinai Hospital in New York City, where he is also chief resident of teaching. His YouTube channel focuses on perioperative medicine, especially the role of the anesthesiologist.
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Anesthesiologist in Glenwood Springs charged with 4 counts of unlawful sexual contact – Denver 7 Colorado News
GLENWOOD SPRINGS, Colo. An anesthesiologist in Glenwood Springs has been charged with multiple counts of unlawful sexual contact.
Mark R. Young, 54, of Glenwood Springs, was arrested on three charges of unlawful sexual contact and one charge of unlawful sexual contact of an at-risk person.
On Dec. 20, 2022, officers with the Glenwood Springs Police Department took a report about a potential sexual assault that happened at APEX Ketamine Therapy. A woman reported that after more than two years of ketamine infusion treatments with Young, "he made sexually inappropriate comments and made unlawful sexual contact after administration of her medication on her last visit," the police department said. The department added that in total, five females of unknown ages were victimized in this case.
Following an investigation, an arrest warrant was issued for Young.
Denver 7+ Colorado News Latest Headlines | April 5, 11am
He was booked into the Garfield County Jail on April 1 on the four charges.
The police department said based on a multitude of factors including the location, history and more they are working to talk with anybody else who may have been victimized. Those individuals can call the police department at 970-384-6500.
According to his most recent licensing documentation from the Colorado Department of Regulatory Agencies, he is board certified in anesthesiology. That document reads that he received disciplinary action in 2012 in Colorado and a restriction or suspension in 2023, though the details on both are unknown.
No other details were immediately available.
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American Society of Biochemistry and Molecular Biology honors MD/PhD student Hannah Kondolf – The Daily | Case Western Reserve University
Hannah Kondolf, a student in the MD/PhD program, was named a Journal of Biological Chemistry Herbert Tabor Early Career Award winner. Kondolf conducted the PhD portion of her program in the lab of Derek Abbott, professor of medicine.
Kondolf worked on pore-forming proteins important in autoinflammatory disorders. While in the Abbott lab, she co-authored manuscripts in Cell and Science Immunology. Her major manuscript made use of a novel protein engineering system to show that the pore-forming protein, Gasdermin A, preferentially inserts into the mitochondrial membranes when activated. The result is the release of mitochondrial DNA, a potent inflammatory stimulation agent.
The American Society of Biochemistry and Molecular Biologya major scientific society with over 11,000 membersgranted Kondolf this award.
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American Society of Biochemistry and Molecular Biology honors MD/PhD student Hannah Kondolf - The Daily | Case Western Reserve University
Biochemistry and transcriptomic analyses of Phthorimaea absoluta (Lepidoptera: Gelechiidae) response to insecticides … – Nature.com
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Life’s Origins: How Fissures in Hot Rocks May Have Kickstarted Biochemistry – Singularity Hub
How did the building blocks of life originate?
The question has long vexed scientists. Early Earth was dotted with pools of water rich in chemicalsa primordial soup. Yet biomolecules supporting life emerged from the mixtures, setting the stage for the appearance of the first cells.
Life was kickstarted when two components formed. One was a molecular carrierlike, for example, DNAto pass along and remix genetic blueprints. The other component was made up of proteins, the workhorses and structural elements of the body.
Both biomolecules are highly complex. In humans, DNA has four different chemical letters, called nucleotides, whereas proteins are made of 20 types of amino acids. The components have distinct structures, and their creation requires slightly different chemistries. The final products need to be in large enough amounts to string them together into DNA or proteins.
Scientists can purify the components in the lab using additives. But it begs the question: How did it happen on early Earth?
The answer, suggests Dr. Christof Mast, a researcher at Ludwig Maximilians University of Munich, may be cracks in rocks like those occurring in the volcanoes or geothermal systems that were abundant on early Earth. Its possible that temperature differences along the cracks naturally separate and concentrate biomolecule components, providing a passive system to purify biomolecules.
Inspired by geology, the team developed heat flow chambers roughly the size of a bank card, each containing minuscule fractures with a temperature gradient. When given a mixture of amino acids or nucleotidesa prebiotic mixthe components readily separated.
Adding more chambers further concentrated the chemicals, even those that were similar in structure. The network of fractures also enabled amino acids to bond, the first step towards creating a functional protein.
Systems of interconnected thin fractures and cracksare thought to be ubiquitous in volcanic and geothermal environments, wrote the team. By enriching the prebiotic chemicals, such systems could have provided a steady driving force for a natural origins-of-life laboratory.
Around four billion years ago, Earth was a hostile environment, pummeled by meteorites and rife with volcanic eruptions. Yet somehow among the chaos, chemistry generated the first amino acids, nucleotides, fatty lipids, and other building blocks that support life.
Which chemical processes contributed to these molecules is up for debate. When each came along is also a conundrum. Like a chicken or egg problem, DNA and RNA direct the creation of proteins in cellsbut both genetic carriers also require proteins to replicate.
One theory suggest sulfidic anions, which are molecules that were abundant in early Earths lakes and rivers, could be the link. Generated in volcanic eruptions, once dissolved into pools of water they can speed up chemical reactions that convert prebiotic molecules into RNA. Dubbed the RNA world hypothesis, the idea suggests that RNA was the first biomolecule to grace Earth because it can carry genetic information and speed up some chemical reactions.
Another idea is meteor impacts on early Earth generated nucleotides, lipids, and amino acids simultaneously, through a process that includes two abundant chemicalsone from meteors and another from Earthand a dash of UV light.
But theres one problem: Each set of building blocks requires a different chemical reaction. Depending on slight differences in structure or chemistry, its possible one geographic location might have skewed towards one type of prebiotic molecule over another.
How? The new study, published in Nature, offers an answer.
Lab experiments mimicking early Earth usually start with well-defined ingredients that have already been purified. Scientists also clean up intermediate side-products, especially for multiple chemical reaction steps.
The process often results in vanishingly small concentrations of the desired product, or its creation can even be completely inhibited, wrote the team. The reactions also require multiple spatially separated chambers, which hardly resembles Earths natural environment.
The new study took inspiration from geology. Early Earth had complex networks of water-filled cracks found in a variety of rocks in volcanos and geothermal systems. The cracks, generated by overheating rocks, formed natural straws that could potentially filter a complex mix of molecules using a heat gradient.
Each molecule favors a preferred temperature based on its size and electrical charge. When exposed to different temperatures, it naturally moves towards its ideal pick. Called thermophoresis, the process separates a soup of ingredients into multiple distinct layers in one step.
The team mimicked a single thin rock fracture using a heat flow chamber. Roughly the size of a bank card, the chamber had tiny cracks 170 micrometers across, about the width of a human hair. To create a temperature gradient, one side of the chamber was heated to 104 degrees Fahrenheit and the other end chilled to 77 degrees Fahrenheit.
In a first test, the team added a mix of prebiotic compounds that included amino acids and DNA nucleotides into the chamber. After 18 hours, the components separated into layers like tiramisu. For example, glycinethe smallest of amino acidsbecame concentrated towards the top, whereas other amino acids with higher thermophoretic strength stuck to the bottom. Similarly, DNA letters and other life-sustaining chemicals also separated in the cracks, with some enriched by up to 45 percent.
Although promising, the system didnt resemble early Earth, which had highly interconnected cracks varying in size. To better mimic natural conditions, the team next strung up three chambers, with the first branching into two others. This was roughly 23 times more efficient at enriching prebiotic chemicals than a single chamber.
Using a computer simulation, the team then modeled the behavior of a 20-by-20 interlinked chamber system, using a realistic flow rate of prebiotic chemicals. The chambers further enriched the brew, with glycine enriching over 2,000 times more than another amino acids.
Cleaner ingredients are a great start for the formation of complex molecules. But lots of chemical reaction require additional chemicals, which also need to be enriched. Here, the team zeroed in on a reaction stitching two glycine molecules together.
At the heart is trimetaphosphate (TMP), which helps guide the reaction. TMP is especially interesting for prebiotic chemistry, and it was scarce on early Earth, explained the team, which makes its selective enrichment critical. A single chamber increased TMP levels when mixed with other chemicals.
Using a computer simulation, a TMP and glycine mix increased the final producta doubled glycineby five orders of magnitude.
These results show that otherwise challenging prebiotic reactions are massively boosted with heat flows that selectively enrich chemicals in different regions, wrote the team.
In all, they tested over 50 prebiotic molecules and found the fractures readily separated them. Because each crack can have a different mix of molecules, it could explain the rise of multiple life-sustaining building blocks.
Still, how lifes building blocks came together to form organisms remains mysterious. Heat flows and rock fissures are likely just one piece of the puzzle. The ultimate test will be to see if, and how, these purified prebiotics link up to form a cell.
Image Credit: Christof B. Mast
Excerpt from:
Life's Origins: How Fissures in Hot Rocks May Have Kickstarted Biochemistry - Singularity Hub
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Differential responses of Hollyhock (Alcea rosea L.) varieties to salt stress in relation to physiological and biochemical ... - Nature.com
Professor Robert Cross awarded Biochemical Society Award for Sustained Excellence – University of Warwick
Professor Robert Cross, Warwick Medical School has been awarded the Biochemical Society Award for Sustained Excellence 2025.
The work and contribution of fifteen eminent bioscientists, outstanding educators and exceptional early career researchers has been acknowledged in the annual Biochemical Society Awards following a record year of nominations.
Each recipient has been recognised for excellence in their field as well as a strong commitment to build, support, and nurture future talent. Winners of the 2025 Awards represent a cross-section of the molecular biosciences ranging from redox biology and plant-microbe interactions to mechanochemistry and virology.
Professor Steve Busby, Professor of Biochemistry at the University of Birmingham, and Chair of the Biochemical Societys Awards Committee, says: "The list of the 2025 Biochemical Society award winners is impressive and, of course, we have a wonderful mix of awardees, since each prize is targeted to a different section of our community. This is due to great foresight by the Societys managers and funders, over many many years. As well as congratulating the winners, I want to say thanks for all the hard work put in by nominators, supporters, Biochemical Society staff and the Awards Panel during the current round, this scheme could not work without you and your efforts made my job easy!
Professor Cross said "The Biochemical Society is a national treasure and I am grateful for this recognition of my work. I like the idea of an award for sustained progress - for me, science is about finding a good problem, splitting it into smaller problems, and working to solve those, as best one can, for as long as it takes."
Professor Cross obtained his PhD in 1983 from the University of Nottingham and then won an EMBO long-term fellowship to work with J. Victor Small and Apolinary Sobieszek in Salzburg on the structure and mechanisms of smooth muscle myosin filaments. In 1986, he moved to MRC-LMB as an MDA fellow and alongside John Kendrick Jones, Clive Bagshaw and Mike Geeves, Rob was ultimately able to propose an explicit mechanism for myosin II self-assembly.
In 1991, he moved to the Marie Curie Research Institute (MCRI) and began work on kinesin, then newly-discovered. In 2005, Rob and Nick Carter found that kinesin can step processively backwards under load. This turned out to be key to its mechanochemical coupling, which, as they recently (2020) showed, combines tight-coupled forwards steps with loose-coupled backslips.
In 2009, the MCRI closed and Rob moved, with his colleagues Professor Andrew McAinsh and Professor Anne Straube, to Warwick Medical School, University of Warwick. At Warwick, Rob continues to interrogate the kinesin mechanism, but with an important paradigm shift, whereby the interlock between the mechanochemical mechanisms of kinesin and tubulin is paramount.
Find out more about the Awards here and find out more about Professor Rob Cross and his research here.
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Professor Robert Cross awarded Biochemical Society Award for Sustained Excellence - University of Warwick
Derm In The News: March 31-April 6 – Dermatology Times
KGET: myDermRecruiter Launches Newly Expanded Job Board for Dermatology Support Roles
myDermRecruiter, a recruitment firm in dermatology, has expanded its job board to include a wide range of essential support roles within dermatology practices. The expansion aims to meet the increasing demand for professionals in roles such as dermatology medical assistants, office managers, instrument techs, and research coordinators. For more information, contact JobBoard@myDermRecruiter.com.
Top headlines from this week to share with your patients:
Incyte and China Medical System Holdings Limited have entered a collaboration to develop and commercialize povorcitinib for various dermatologic diseases in Mainland China, Hong Kong, Macao, Taiwan, and certain Southeast Asian countries. The agreement grants CMS an exclusive license to develop and commercialize povorcitinib in autoimmune and inflammatory dermatologic diseases, including non-segmental vitiligo, hidradenitis suppurativa, prurigo nodularis, and chronic spontaneous urticaria.
We covered this news! Read more here.
Kavya Odari, a Nepalese refugee who moved to the US at 3 years old, founded K.O. Cosmetics in 2020, driven by her own experiences of being bullied for her culture and appearance. Her brand aims to provide inclusive beauty products for all skin tones and types.
The FDA is considering updating its 2013 premarket guidance for pulse oximeter manufacturers due to research indicating inaccuracies in readings for patients with dark skin. Studies show that pulse oximeters may overestimate blood oxygen levels for these patients, leading to incorrect diagnoses and treatments. Attorneys general from 24 states, including Arizona, urged the FDA to take action, proposing clear warning labels for reduced effectiveness based on skin tone.
Have you seen any dermatology headlines this week that we may have missed? Share with us by emailing our team atDTEditor@mmhgroup.com.
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Dr. Hillary Johnson-Jahangir of Forefront Dermatology Designated as a Candela Center of Excellence – PR Newswire
CORALVILLE, Iowa, April 3, 2024 /PRNewswire/ --Candela Corporation announced today that it is partnering with Dr. Hillary Johnson-Jahangir of Forefront Dermatology Laser and Surgery Center in Coralville, Iowa as a new Candela Center of Excellence.
Forefront Dermatology joins this prestigious community of clinics across the country that are designated as Candela Centers of Excellence for their commitment to the practice and teaching of medical aesthetics using Candela's portfolio of energy-based devices.
Hillary Johnson-Jahangir, MD, PhD, MS, FAAD, FACMS, is a board-certified dermatologist and board-certified and fellowship trained Mohs micrographic skin cancer surgeon with over 15 years of experience. She is the founding director of the Forefront Dermatology Laser and Surgery Center. Specializing in the treatment and prevention of skin cancer, Dr. Johnson offers advanced laser care and has extensive experience with the GentleMax Pro, Vbeam, Nordlys, PicoWay, and CO2RE systems.
Dr. Johnson is a longstanding member of theAmerican Society for Laser Medicine and Surgery. Her aesthetic sensibility was honed by years of training and practice in New York City where she was Director of Dermatologic Surgery at Weill Cornell Medical Center. Dr. Johnson also practiced laser and surgical dermatology at the University of Iowa for 7 years where she received awards for teaching and making a difference in patient care.
Dr. Johnson has been recognized as an Iowa Medical Society Women in Medicine Month Leader and an Inspirational Leader by the American Medical Association Women Physicians Section. She is also a published author of several peer-reviewed journal articles and book chapters and has lectured at universities and national meetings of multiple medical associations.
"We are thrilled to announce our partnership with Dr.Johnsonin establishing a Candela Center of Excellence dedicated to advancing education in energy-based devices," says Mary Trout, Chief Commercial Officer,Candela Corporation. "Dr.Johnson's commitment to excellence and innovation aligns perfectly with Candela's mission to empower professionals in the field of medical aesthetics and spread patient awareness on the benefits of energy-based device procedures. Together, we look forward to shaping the future of energy-based treatments and education, setting new clinical standards, and delivering transformative experiences for patients."
Forefront Dermatology, Candela Center of Excellence is located at: 2769 Heartland Drive, Suite 303, Coralville, IA 52241.
About Candela Corporation
Media contact: Laurel Sanderson [emailprotected]
SOURCE CANDELA
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