Juan José Janer’s Post

𝗠𝗮𝗻𝗮𝗴𝗶𝗻𝗴 𝗲𝗽𝗶𝘀𝘁𝗮𝘅𝗶𝘀 𝗶𝗻 𝗛𝗛𝗧 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝗿𝗲𝗺𝗮𝗶𝗻𝘀 𝗮 𝗰𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗰𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲. For those living with Hereditary Haemorrhagic Telangiectasia (HHT), recurrent nosebleeds are often severe, unpredictable, and impact quality of life. Conventional treatments such as cautery, packing, and laser ablation can help, but frequently come with downsides: crusting, trauma, or the need for repeated interventions under general anaesthesia. That’s why ENT teams are beginning to explore the role of PuraBond (RADA16), a transparent, self-assembling peptide hydrogel, as a supportive in-office adjunct in HHT-related epistaxis. What does the clinical evidence show? 🔹 𝗨𝗻𝗶𝘃𝗲𝗿𝘀𝗶𝘁𝘆 𝗼𝗳 𝗙𝗹𝗼𝗿𝗶𝗱𝗮 𝗰𝗼𝗵𝗼𝗿𝘁 (𝟮𝟬𝟮𝟱): 18 HHT patients treated with direct PuraBond application to nasal telangiectasias → Improved Epistaxis Severity Scores → No adverse events, allergic reactions, or pain reported → Less crusting and healthier-appearing mucosa at follow-up 🔹 𝗧𝘂𝗿𝗯𝗶𝗻𝗮𝘁𝗲 𝗦𝘂𝗿𝗴𝗲𝗿𝘆 𝗦𝗲𝗿𝗶𝗲𝘀 (𝟮𝟬𝟮𝟱): 985 patients undergoing turbinate reduction, with or without PuraBond → Crusting reduced → Mucosal re-epithelialisation observed → Reliable haemostasis and reduced post-op bleed rates → No product-related complications Rather than replacing existing methods, PuraBond is being integrated into ENT practice to help support haemostasis, protect fragile mucosa, and reduce procedural trauma, especially in patients with underlying vascular fragility like HHT. 📎 Peer-reviewed papers linked in the first comment below. I will also attach a video showing PuraBond being used in a live HHT case. #HHT #Epistaxis #ENTsurgery #RADA16 #PuraBond #Haemostasis #Endonasal #Telangiectasia #PatientCare #Otolaryngology #ENTInnovation

#VSD Ventricular Septal Defect ⚡️⚡️Definition⚡️⚡️ Ventricular septal defect (VSD) is a congenital opening (hole) in the interventricular septum, which connects both ventricles of the heart ⚡️⚡️Circulation⚡️⚡️ Normally, the left side of the heart only pumps blood to the body, and the heart's right side only pumps blood to the lungs. In a child with VSD, blood can travel across the hole from the left pumping chamber (left ventricle) to the right pumping chamber (right ventricle) and out into the lung arteries. If the VSD is large, the extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lungs can become congested. Fig.21 Normal Circulation Vs. VSD ⚡️⚡️Types⚡️⚡️ There are four basic types of VSD: 1️⃣ Membranous VSD. (This VSD is, by far the most common type, accounting for 80% of all defects) An opening in a particular area of the upper section of the ventricular septum (an area called the membranous septum), near the valves. This type of VSD is the most commonly operated on since most membranous VSDs do not usually close spontaneously. 2️⃣Muscular VSD. An opening in the muscular portion of the lower section of the ventricular septum. A large number of these muscular VSDs close spontaneously and do not require surgery. 3️⃣Atrioventricular canal type VSD. A VSD associated with atrioventricular canal defect. The VSD is located underneath the tricuspid and mitral valves. 4️⃣Conal septal VSD. The rarest of VSDs which occur in the ventricular septum just below the pulmonary valve. Ventricular septal defects are the most commonly occurring type of congenital heart defect, accounting for about half of congenital heart disease cases. ⚡️⚡️Surgical Management⚡️⚡️ • Surgical repair🩸. The goal is to repair the septal opening before the lungs become diseased from too much blood flow and pressure. Your child's cardiologist will recommend when the repair should be performed based on echocardiogram and (less common) cardiac catheterization results. Pulmonary artery banding (PAB)🩸: PAB is done to reduce excessive pulmonary blood flow and protect the pulmonary vasculature from hypertrophy and irreversible (fixed) pulmonary hypertension. The operation is performed under general anesthesia. Depending on the size of the heart defect and your doctor's recommendations, the ventricular septal defect will be closed with stitches or a special patch. • Interventional cardiac catheterization🩸 ⚡️⚡️Postoperative Complications⚡️⚡️ . Postoperative bleeding requiring re explanation, valve injury (tricuspid, pulmonary, or aortic) . Pulmonary hypertension . Poor cardiac output . AV heart block . Residual VSD with continued left-to-right shunting . Bacterial endocarditis . Death ⚡️⚡️Nursing Management⚡️⚡️ • Routine postoperative care

Our Endoscope baskets are specialized medical devices used to retrieve foreign objects, stones, or tissue samples from the body's internal cavities, such as the gastrointestinal tract, urinary tract, or respiratory system. These baskets are designed to be used with endoscopes, which provide visualization and access to the affected area. Uses of Endoscope Baskets: 1. Foreign Object Retrieval: Endoscope baskets are used to retrieve swallowed objects, such as coins, batteries, or other small items, from the gastrointestinal tract. 2. Stone Retrieval: These baskets are used to retrieve stones from the urinary tract, bile ducts, or pancreatic ducts. 3. Tissue Sampling: Endoscope baskets can be used to collect tissue samples for biopsy or histopathological examination. 4. Therapeutic Interventions: Endoscope baskets are used in various therapeutic interventions, such as removing gallstones or other obstructive lesions. Benefits of Endoscope Baskets: 1. Minimally Invasive: Endoscope baskets allow for minimally invasive procedures, reducing the risk of complications and promoting faster recovery. 2. Precise Control: These baskets provide precise control, enabling healthcare professionals to navigate complex anatomy and retrieve objects or samples with accuracy. 3. Improved Patient Outcomes: Endoscope baskets can improve patient outcomes by reducing the need for surgical interventions and promoting faster recovery times. Features of Our Endoscope Baskets: 1. High-Quality Materials: Our endoscope baskets are made from high-quality materials, ensuring durability and reliability. 2. Precise Design: Our baskets are designed to provide precise control and maneuverability, enabling healthcare professionals to navigate complex anatomy with ease. 3. Sterilizable: Our endoscope baskets are designed to be sterilized, ensuring patient safety and reducing the risk of infection. Why Choose Our Endoscope Baskets? 1. Quality and Reliability: We offer high-quality products that meet the highest standards of reliability and performance. 2. Clinical Expertise: Our team has extensive clinical expertise in gastroenterology, urology, and other specialties, ensuring that our products meet the needs of healthcare professionals. 3. Customer Support: We provide exceptional customer support, including training, education, and technical assistance, to ensure that our products are used effectively and safely. #endoscopebasket #medicaldevices #gastroenterology #urogoly #endsocopy #daudjeemfg #manufactrures #cssdtrays #sterilizationbaskets #medica2025

Lower Limb Pain — Not Just “Discopathy” Case Presentation & Resident’s Plan:  Resident: “We have a 59-year-old man sent from the clinic for admission with left lower limb pain for 72 hours. He is suspected of having lumbar discopathy and requested MRI and admission to the medicine floor. I planned to admit him as requested.” Attending: “Okay. Before admitting, tell me about his limb exam — pulses, temperature, and color?” Resident: “I didn’t focus much on vascular findings since he was already diagnosed with a radiculopathy. The limb was painful, but I didn’t note anything alarming.” Attending’s Guiding Question: “What if this pain isn’t descopathy at all? What would explain pain without a clear back component — and how would checking pulses change the diagnosis?” Re-evaluation & New Findings: Prompted by the attending, the resident re-examines the leg. The left foot is cool, with weak femoral and dorsalis pedis pulses. Capillary refill is delayed. Bedside POCUS shows abnoramal power Dopler flow in the left femoral artery — consistent with acute femoral artery thrombosis and stenosis. Instead of admission, the case is discussed with the vascular surgery team. Attending’s Explanation & Corrected Plan: Resident: “I see now — I anchored on the clinic's diagnosis and skipped a full vascular exam.” Attending: “Exactly. Always verify for yourself. Lower limb pain is not always spine-related. Acute limb ischemia is a time-critical emergency — every hour counts for tissue salvage. Never stop being the patient’s final checkpoint. Our responsibility is to collect all necessary data before making an admission or diagnosis. Reviewing a senior colleague’s decision isn’t insubordination — it’s thoroughness. It’s how we protect patients and uphold the integrity of our profession. When something doesn’t align with evidence or patient context, your role is to politely seek clarification. Contrast in Outcomes: Always feel the pulses — never skip your own bedside assessment. Follow me & EM Mastery Academy for more real-world rounds that sharpen diagnostic vigilance and interdepartmental communication. #EmergencyMedicine #PatientSafety #ClinicalReasoning #AnchoringBias #BedsidePOCUS #VascularEmergency #AttendingRounds #ResidencyEducation

🫀 We don’t opt for #protectedVT ablation often, and our is experience that it isn’t needed in many patients. But in some select cases it can be the gamechanger. The PAINESD score is sensitive but not specific because in many patients with a high PAINESD #VTablation can be performed safely without mechanical support. (see 1)   In this ICM patient s/p three VT ablation procedures with an LVEF of 15% and extensive LV scar, recent VT episodes caused immediate hemodynamic collapse with prolonged CPR. We therefore decided that hemodynamic support was the prudent choice See video for procedural details. An #Impella CP was placed via the left femoral artery at the start of the procedure. (cheers Samuel Lee 🤝) We had #InHeart CT data available. (another rabbit hole, see 2.) Maps acquired with #HDgridX and created by master mapper Malte Wader aka Mapelangelo (another gamechanger this guy). All mapping and ablation via antegrade transseptal access. The #mitralclip wasn't an issue (it usually isn't, see 3.)   VT#1 probably relied on epicardial substrate but was successfully ablated from the endocardium. (see 4.) Patient was non-inducible at the end.  ✅ Impella removed on the table, Impella access closed with 2x Perclose and 1x Angioseal. Total duration 3:15h. All done under cardiologist led sedation, no anesthesiology, no pressors. (see 5.) Patient was discharged 2 days later. Patient selection for #protectedVT ablation deserves closer scrutiny — the variability between centers is remarkable, and patient characteristics alone don’t explain the differences in Impella utilization. In this case hemodynamic support surely made a difference. 1)       https://lnkd.in/eJQnFpfW 2)       https://lnkd.in/ey7Atrvk (Jan-Hendrik van den Bruck) 3)       https://lnkd.in/eR7Yt7Ha (Moneeb Khalaph) 4)       https://lnkd.in/eTZ_aSTD (Arian Sultan) 5)       https://lnkd.in/eavrEZ5E (PD Dr. med. Helge Servatius) Daniel Steven, Jana Ackmann, Jonas Wörmann, Sebastian Dittrich, Abdul Parwani, Immanuel Erdmann, Prashanthan Sanders, Christian Meyer

In a recent Gastrointestinal Endoscopy publication, Dr. Nick Shaheen (MD, MPH, MASGE) shares his “Top Tips” for effectively managing refractory Barrett’s esophagus (BE) — a persistent challenge in gastroenterology despite advances in endoscopic therapy. Barrett’s esophagus remains a widespread premalignant condition, and while modern ablation and resection techniques have transformed management, recurrent or treatment-resistant cases continue to pose significant clinical dilemmas. Dr. Shaheen provides practical, experience-driven strategies to help clinicians: 🔹 Identify factors contributing to BE recurrence or incomplete eradication. 🔹 Optimize procedural techniques and follow-up surveillance. 🔹 Balance the need for aggressive treatment with patient safety and long-term outcomes. His insights underscore the importance of precision, persistence, and multidisciplinary care in achieving durable remission and preventing progression to esophageal adenocarcinoma. 📖 Read the full article: https://lnkd.in/e_qv2DgX #Gastroenterology #Endoscopy #BarrettsEsophagus #GIEndoscopy #NicholasShaheen #RefractoryBE #ClinicalPractice #DigestiveHealth #OncologyPrevention #MedicalEducation

🫀 Prosthetic Heart Valves: what every clinician should know Valve replacement transforms prognosis in severe valvular disease—but our post-operative vigilance determines the outcome. Mortality from valve dysfunction or endocarditis can exceed 20% if complications go unnoticed early (ESC 2021). 1️⃣ Types & Key Differences • Mechanical valves – durable (>20 yrs), require lifelong anticoagulation (target INR 2.5–3.5). • Bioprosthetic valves – lower thrombogenicity, no long-term anticoagulation, but structural degeneration within 10–15 yrs. Choice depends on age, bleeding risk, pregnancy plans, and patient preference. 2️⃣ Immediate Post-operative Priorities • Hemodynamic stability: monitor preload, afterload, and LV function—TTE or invasive lines help detect tamponade or low-output state. • Bleeding & coagulopathy: check drainage volume > 200 ml/hr; reverse anticoagulant excess promptly. • Arrhythmia surveillance: AF occurs in 30–50% of valve surgeries; early rate or rhythm control is key. • Renal & hepatic function: monitor due to CPB-related ischemia. 3️⃣ Echocardiographic Assessment 🩺 A baseline TTE within 24–72 hrs establishes gradients, seating, and paravalvular leaks. Look for: – Mean pressure gradient (compare with manufacturer specs). – Effective orifice area (EOA). – Absence of rocking motion or abnormal regurgitant jets. – For mechanical valves, assess opening/closing clicks—absent sound = possible thrombosis. 4️⃣ Long-term Care & Follow-up ✅ Maintain therapeutic INR (educate, don’t assume adherence). ✅ Antibiotic prophylaxis for high-risk dental/GI procedures. ✅ Annual echo for bioprosthetic valves, 5-yearly for mechanical (ESC 2021). ✅ Emphasize lifestyle modification and infective endocarditis prevention. Clinical takeaway: The prosthetic valve patient is never “discharged from cardiology.” Lifelong follow-up, meticulous anticoagulation, and early recognition of dysfunction remain our strongest defense against late MACE. How do you structure your post-operative surveillance for valve patients in resource-limited settings? #Cardiology #CardiacSurgery #ValvularHeartDisease #Echocardiography #PostoperativeCare #GlobalHealth

Is HALO a bleeding-free procedure? Let’s separate fact from fiction. Haemorrhoidal Artery Ligation Operation (HALO), also known as Doppler-guided HAL, is widely adopted as a minimally invasive treatment for grade II–III haemorrhoids. But while it’s less invasive than traditional methods — is it truly bleeding-free? 📉 The evidence says: Not entirely, but the risk is low. • A systematic review of 28 studies (n=2,904) found an overall postoperative bleeding rate of 5%. • Some single-centre studies report even lower rates (1.4%–1.9%). • Most bleeding is minor and self-limiting — very few patients require re-intervention. 📌 Key Risk Factors for Postoperative Bleeding: 1. Site of excision — Bleeding is more likely when HAL is combined with rectoanal repair (HAL-RAR), particularly if sutures are placed near sensitive, vascular areas. 2. First bowel movement — Early straining or inadequate laxative use can provoke bleeding during initial defecation. 3. Male gender — Some studies suggest male patients may be at slightly higher risk, possibly due to anatomical or behavioural factors (e.g., delayed presentation, higher baseline pressure). 📊 HAL vs Excisional Hemorrhoidectomy Compared to traditional haemorrhoidectomy, HAL has: • Lower bleeding risk • Less postoperative pain • Faster recovery • Lower reoperation rate for selected patients 🩺 The 2024 ASCRS guidelines support HAL as a safe, effective option with a low overall complication rate, including bleeding. ✅ Bottom line: HAL is not completely bleeding-free, but with a 1–5% risk — mostly mild — it remains a safe, minimally invasive alternative to excisional surgery for the right patient. 💬 Interested in how to reduce bleeding risks post-HAL? Or want to know which patients might benefit most from this approach? Let’s connect. #ColorectalSurgery #HALO #Hemorrhoids #SurgicalOutcomes #PatientSafety #MinimallyInvasive #ASCRS #EvidenceBasedMedicine

⚙️ Enhancing Airway Clearance Efficiency with HFCWO Technology Lawzah Medical Company is introducing the High-Frequency Chest Wall Oscillation (HFCWO) system — a hospital-grade solution engineered to deliver precise, automated airway clearance therapy for patients with compromised pulmonary function. 🔬 Technical Highlights: Frequency Range: 1–20 Hz Pressure Range: 3–30 mmHg Session Duration: 1–99 minutes (average clinical session: 20 minutes) Interface: 8-inch full-color LCD touch screen with automated workflow Safety: Soft mechanical force design minimizes rib or skin injury, even in unresponsive patients Power Supply: 100–240 VAC, 400VA, 50 Hz Controller Weight: 14.5 kg 💨 Integrated Capabilities: Nebulization: ≥3 L/min gas flow, ≥0.16 mL/min atomization rate Negative pressure suction: ≥0.08 MPa, ≥20 L/min airflow, 2L storage capacity Automatic cough detection and remote emergency stop function 🩺 Clinical Applications: Effective for asthma, bronchiectasis, cystic fibrosis, COPD, pneumonia, spinal cord injury, tracheostomy care, and post-operative airway management. 🏥 Recommended Hospital Departments: ICU | Pulmonology | Neurosurgery | Rehabilitation | Pediatrics | Gerontology | Cardiothoracic Surgery 🔑 Procurement Advantages: Demonstrated 2–3× higher efficacy in mucus clearance compared to manual chest physiotherapy Reduced clinician involvement — semi-autonomous operation optimizes workflow Adaptable configurations: PV-100, PV-300, and PV-900 models with reusable or disposable vests and straps in multiple sizes By integrating HFCWO systems, hospitals can improve patient outcomes, enhance respiratory care efficiency, and optimize resource utilization. #LawzahMedical #HFCWO #BiomedicalEngineering #RespiratoryTherapy #CriticalCare #HospitalTechnology #MedicalDevices #AirwayManagement

Roux-en-Y gastric bypass (RYGB) remains one of the most effective surgical interventions for morbid obesity, demonstrating profound and sustained weight reduction along with significant remission of obesity-related comorbidities such as type 2 diabetes mellitus, hypertension, and dyslipidemia. However, its therapeutic benefits are balanced by the risk of diverse early and late complications, ranging from anastomotic leaks and hemorrhage to micronutrient deficiencies and internal herniation. These complications necessitate a vigilant, multidisciplinary approach involving surgeons, nurses, dietitians, pharmacists, and allied health professionals. Early recognition and timely intervention are critical to improving patient outcomes and reducing morbidity and mortality. This article provides a comprehensive discussion of RYGB-associated complications, their clinical relevance, and the role of an integrated healthcare team in optimizing postoperative care and long-term monitoring. By fostering effective interprofessional collaboration and evidence-based clinical practice, healthcare teams can significantly enhance the safety, efficacy, and durability of bariatric surgical outcomes.