r/medizzy

Cardiologists.
They walk among us.
In our hospitals, our coffee shops, and our dating apps(at an oddly high frequency on Raya).

Once a year, this curious species of heart enthusiasts pilgrimage to a secret location to nerd out over all things cardiovascular. 

This year, it was Madrid for : Comicon for Cardiology.

So much glorious research to sink our teeth into…but the premier study was this:
The REBOOT Trial, published in the .

Here’s what we know:
It's good to give beta-blockers as a treatment for those with heart failure.
But ONLY IF they have reduced ejection fraction (<40%).
It’s been well established by trusted sources (the Passmed High-yield textbook) that it has no effect on those with preserved ejection fraction(HFpEF = >50%).

But there is a flaw.
This fact had been established back in the 1970's. The Seventies…? 

Aside from the fact that this research was likely conducted by scientists high on a potent cocktail of edibles and quaaludes, the science itself predates basically everything we now consider standard: No statins. No stents. No PCIs, which didn’t become routine until the 2000s.

So these researchers decided this management plan was due a REBOOT(see what i did there ;)  

This open-label RCT set out to determine if beta-blocker actually did reduce mortality in heart failure >=40% in the modern era.

8,438 patients across Spain and Italy were included in this trial (Avg Age: 61.3yrs, 19.3% women, 88.2% received PCI after MI). They were randomised 1:1 to a beta-blocker and non beta-blocker group.
The beta-blocker of choice was bisoprolol – 85.9% of participants were on it. 

And they found… no significant difference 

• Frequency of the composite primary outcome(deaths, reinfarctions and hospitalisation for HF) 316 v 307 in the beta-blocker and non beta-blocker groups respectively.

• When breaking down the composite primary outcome into its subgroups there was no significant difference either:

• Deaths: 161 Beta-blocker vs 153 no beta-blocker.

• Reinfarctions: Exactly 143 in both groups.

• Hospitalisation: 39 patients vs 44 patients.

Kinda underwhelming :/ 

Luckily, no idea is original. There were 3 other studies with similar aims: BETAMI, DANBLOCK and CAPITAL-RCT. So what happens when you put all these results together?
That's right… . 

The results here greatly contrasted the REBOOT trial alone:

• The primary endpoint occurred in 10.7% of the beta-blocker group vs 14.4% in the no beta-blocker group– a significant 25% relative reduction with beta-blockers. 

• This was also reflected in the individual component of the composite outcome

• Deaths: 5.9% Beta-blocker vs 7.7% no beta-blocker.

• Reinfarctions: 3.9% vs 5.2% 

So whilst the REBOOT trial disagrees, the meta-analysis shows the patients with HF mildly reduced ejection fraction(40-49%) can share in the beta-blocker love long-term. More work to be done to see if HFpEF can potentially benefit too.

Just be sure to leave asthmatics out of the picture. It always ends ugly when they're involved.

If you enjoyed reading this and want to get smarter on the latest medical research

Does RFK jr. actually have a brain worm:

So the answer is probably but there is some speculation that he doesn't. The brain worm was first brought to public attention during his divorce to his second wife. his defense used his brain worm, and an unrelated high mercury level to claim that he has less earning potential due to cognitive impairment, to reduce this new York times article goes over the detail a little bit () this seems liek a bullshit excuss to reduce possible losses during his divorce, but the underlying high Hg levels and brain worm are likely true, they just didnt reduce his cognitive impairment.

if so what is the Brain worm?:

During scans it was observed that RFK had a dark spot on his scans with doctors eventually concluding it was a worm cycst. Specifically he had a pork tapeworm, taenia solium, cyst (detail life cycle below). RFK initially got the scan after "experiencing memory loss and mental fogginess " , which may or may not be related to the cyst.

SO what is pork tapeworm/how did he get it in his brain/ is this common?

So pork tapeworm is one of numerous tapeworm species present in people. Like all tapeworms the parasite has two host life cycle with cyst stages found in the tissue of pigs and the adult worm is found in the human intestine. the intestine stage it the stereotypical long segmented worm that most people would probably imagine. Now the way the life cycle works: people poop out the eggs of the tapeworm, and in unsanitary conditions, some of these eggs will make there way to a pig. once in the pig the eggs hatch and the larvae penetrate out of the gut and enter the blood stream. once in the blood the larvae will travel around the body and randomly exit to form cysts. These cysts can live in the tissue for several years, and are waiting for a pig to be butchered and eaten by a person. if eaten by a person, the cyst will break open and an adult worm will form in someone's gut to restart the life cycle. Cooking and freezeing meat can kill these cysts.

Now how did RFK get it? well when someone has an adult tapeworm infection and they use the bathroom, some eggs can get on there hands. then if this person prepares food, the food can then be contaminated by the eggs on there hand, thus exposing the tapeworm eggs to the person. Now because human and pig guts "look" similar to the tapeworm, the worm "thinks" its in a pig gut and acts accordingly. so it will enter the blood stream and encyst randomly. when a cyst forms in the muscle it is called cysticercosis, and when it ends up in the brain it is called neurocysticercosis. So this is most likely what happened to RFk jr., he has traveled in a lot to countries where this parasite is endemic so he likely got exposed to the eggs through someones cooking. Now this ONLY happens in the pork tapeworm, cow tapeworms eggs for example will pass harmlessly through someone as our guts are distinct enough to not cause this issue. Additionally adult tapeworms cause VERY little pathology and most people who have a tapeworm will have no idea

IS IT COMMON?:

Yes and no, if you live in the US, the CDC reports 1-5k cases of neurocystercosis every year, but these are largly in immigrant communities, so it is considered rare here. However in many developing countries this parasite is endemic and seroprevalence (antibodies showing someone has had an infection) can range from 5-30% (Peru for example) [study where i found this info] meaning that in these countires up to a third of the population can harbor some kind of cysts ()

Fun fact, this disease was also the features disease of the pilot episode for HOUSE MD tv show .

What does brain worm do?

the most common side effect of neurocysticercosis is seizures, with neurocysticercosis being one of the leading factors causing adult onset epilepsy. Most of the symptoms are actually associated with the worm cysts dying in someone's brain. while the worms are live in their cyst they dont trigger much of an immune response but once they die the immune response flairs and this can cause complications.

it can also cause other issues like fatigue, nausea, headaches and several other complications though seizures are the most common (occurring in ~75% of identified patients). complications from this parasite are corelated to how many cysts are present in the brain as well. from my readings it seems rfk only has a single cyst, so this is why he liekly never had many symptoms other than some general symptoms that could be a result of his previous drug use or his high mercury levels(from eating too much tuna)

Is this RFKs fault:

This isn't his fault. This disease is picked up by a lot of people, even those who are super hygienic (though rfk isnt).

SOURCES:

5. Carpio, A., 2002. Neurocysticercosis: an update. The Lancet infectious diseases, 2(12), pp.751-762.

6. Del Brutto, O.H., 2014. Neurocysticercosis. Handbook of clinical neurology, 121, pp.1445-1459.

7. Del Brutto, O.H., 2012. Neurocysticercosis: a review. The Scientific World Journal, 2012(1), p.159821.

TLDR: RFK jr most likely has a pork tapeworm cysts in his head, but this has caused relatively little harm. this disease isnt uncommon in the developing world and RFK likely got it while traveling. this worm has likely had little effect on his mental capacity, so dont blame the worm.

VIDEO: If you dont want to read or want even more details: i made this () going into much greater detail about his brain worm and some stories about the parasite like how it impacted the Brooklyn Jewish population in the 90s

In 2010, I was involved in a motorcycle accident. A car pulled out of a parking lot as I was riding, and we collided head-on. I was thrown from my motorcycle and landed on the asphalt. Fortunately, I was only travelling at 50 km/h, so I only fractured my femur and miraculously did not sustain any other injuries.

I had to remain immobile for three days, with 10 kg of weight attached to realign my femur. After that, I underwent surgery where they inserted nails and screws, which I had to keep in for about a year and a half. Over time, I had several more operations: first to remove the screws, then to remove the nail, and finally to remove a callus that had formed on my hip above the nail hole after it was taken out.

Hi, I’m 29f and was considering getting an elective tonsillectomy. My doctor is against it, but she has agreed to advocate for me to my insurance if I truly want it. I have always had large tonsils. I had a lot of issues with strep as a kid, but as an adult they just make it difficult to sleep sometimes and may be the cause of my sleep apnea. Wasn’t really looking for medical advise, just wanted to know if any docs or med students here could tell me why doctors would advise against the surgery, and for those of you who have had your tonsils removed as an adult, what was your experience and how long did it take you to recover?

I'm looking for uncut video of the injury that occurred in the Lions vs Falcons game this week. I teach EMT and paramedic classes and would like to use it in class. All I can find are short clips, slo-motion video of the hit and still pictures from the event. Thanks.