In a new "Beyond the Guidelines" feature, two critical care specialists discuss and debate conditional guideline recommendations on using lactate to guide resuscitation, the use of balanced crystalloids versus normal saline, and the use of corticosteroids for management of sepsis and septic shock. All "Beyond the Guidelines" features are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center (BIDMC) in Boston and include print, video, and educational components published in the Annals of Internal Medicine.

Sepsis is a potentially life-threatening systemic dysregulatory response to infection, and septic shock occurs when sepsis leads to systemic vasodilatation and subsequent tissue hypoperfusion. In 2021, the Surviving Sepsis Campaign published updated guidelines on the management of sepsis and septic shock. Although these guidelines provide a useful review of key recommendations and evidence, some issues remain incompletely resolved.

BIDMC Grand Round discussants Drs. Katherine Berg and Taison Bell recently debated several weak recommendations from the 2021 Surviving Sepsis Campaign guidelines with regard to the case of Ms. S., a 70-year-old woman with septic shock.

In their assessments, Dr. Berg finds lactate level testing to be a quick, inexpensive, and useful indirect measurement to assess illness severity and guide resuscitation. Dr. Bell prefers to rely on dynamic assessments of intravascular volume status to guide fluid resuscitation.

Dr. Berg favors balanced crystalloids (BCs) for resuscitation, especially for patients with acute kidney injury (AKI), such as Ms. S. Dr. Bell believes the debate over fluid choice is less important than otherwise perceived both because of the general trend toward less fluid resuscitation in critical illness and because of the inconsistent results in trials comparing BCs to normal saline.

Dr. Berg does not routinely employ corticosteroids in the first 24 hours in patients in whom shock is stable or improving, but when necessary prefers a regimen of hydrocortisone plus fludrocortisone given the strongest data associated with this combination. Dr. Bell finds corticosteroids to be beneficial due to the improvement in important outcomes like time receiving vasopressors, duration of mechanical ventilation, and ICU length-of-stay.

PANICKED Vladimir Putin has dramatically classified bombshell data which appears to prove he has been treated for cancer.

Rumours have persistently swirled that the tyrant, 70, is "critically ill" - fuelled by his bloated face and trembling legs.

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Bombshell spy documents leaked to The Sun appeared to confirm Putin has pancreatic cancer and early-stage Parkinson's disease.

Now the panicked Russian leader has desperately classified medical files that reveal an apparent cancer battle as he fears a coup inside the Kremlin.

A loophole previously allowed investigative journalists to show that the dictator was constantly accompanied by a top thyroid cancer specialist and other medics.

Revelations last April indicated surgeon Yevgeny Selivanov, of Moscow's Central Clinical Hospital, had flown to Putin no less than 35 times in Black Sea resort Sochi.

The proof of Putin’s treatment by cancer doctors was deduced from the existence of contracts with the hospital which were listed on a Russian public procurement website.

Now such details have been made top secret, preventing public knowledge of current and future contracts.

Earlier it was seen that Putin was accompanied by between six and 13 medical specialists on his trips.

Medics were also seen to be on standby near his favourite official residences outside Moscow, for example in Sochi and Valdai.

The report by Proekt media in April gave credence to rumours that Putin had suffered from cancer.

Medics appeared to be thyroid and ENT specialists.

It comes after it was revealed the Russian government has built a secret network of rail lines that lead to Putin's residences - and train stations nearby.

The blocking of data of such contracts was revealed by Sirena, part of Radio Liberty.

The move is likely to increase speculation that the Kremlin is hiding the truth about Putin’s health during the war against Ukraine.

Symptoms of thyroid cancer include the appearance of a thick nodule in the thyroid area; hoarseness of voice; difficulty swallowing; pain in the neck and throat; enlarged lymph nodes in the neck; a dry cough, scratchy or scratchy feeling in the throat or behind the sternum.

There have also been claims that Putin is suffering from abdominal cancer and other ailments.

Meanwhile, there have been suggestions that drugs to treat his cancer may have distorted his mind when he launched the war in Ukraine.

The Kremlin insists that Putin is healthy.

Among the medics named as treating Putin were Dr Dmitry Verbovoy, an expert in acute illnesses, injuries and poisonings.

Another was Dr Konstantin Sim, an orthopaedic traumatologist, possibly helping with ice hockey injuries, ENT doctor Alexei Shcheglov and infectious disease specialist Yaroslav Protasenko.

He was also seen by neurosurgeons from the Central Clinical Hospital, led  by department head Oleg Myshkin and Dr Elena Rastrusina, plus a resuscitator

Dr Pavel Sharikov, and  head nurse Lyudmila Kadenkova.

A rehabilitation specialist was also involved, Dr Mikhail Tsykunov.In July 2020, Putin met with the head of the National Medical Research Center for Endocrinology, Ivan Dedov.

It comes after the former head of MI6 suggested said there could be a coup inside the Kremlin to oust Putin - but the mechanisms for political change in Russia are "fragile".

Sir Richard Dearlove told The Sun: "I think we're heading into another phase where you're going to get a political upheaval as a result of a war gone badly wrong.

"There could be a coup inside the Kremlin.

"I don't think there will be a popular uprising in Russia, but because of the catastrophic situation they're in, there must be massive tensions in the current leadership."

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The MarketWatch News Department was not involved in the creation of this content.

Feb 01, 2023 (Concur Wire via Comtex) -- New Jersey, United States: A new business intelligence report released by Infinity Business Insights with title Global Medical Tourism Market research report provides a thorough examination of the industry. This research provides an analytical representation of the sector, as well as current trends and future projections, in order to identify likely investment opportunities. The study includes information on the major market drivers, inhibitors, opportunities, and challenges. The study provides an in-depth examination of the market's major segments, trends, drivers, constraints, competitive environment, and other critical elements.

The MarketWatch News Department was not involved in the creation of this content.

The increase in the number of the endoscopic procedures, an increase in the prevalence of chronic diseases, the surge in demand for a minimally invasive procedure, and increase in unmet healthcare needs drive the growth of the global endoscopy fluid management market.

PORTLAND, Ore., Feb. 16, 2023 /PRNewswire/ -- Allied Market Research published a report, titled, "Endoscopy Fluid Management Market by Product (Endoscopy fluid management system, Endoscopy fluid management accessories), by Application (Laparoscopy, Hysteroscopy, Others), by End User (Hospital, Clinics, Others): Global Opportunity Analysis and Industry Forecast, 2021-2031". According to the report, the global endoscopy fluid management industry generated $640.6 million in 2021, and is anticipated to generate $1.29 billion by 2031, witnessing a CAGR of 7.2% from 2022 to 2031.

Download Free demo Report- https://www.alliedmarketresearch.com/request-sample/11331

Prime determinants of growth

The increase in the number of the endoscopic procedure, an increase in the prevalence of chronic diseases such as gastric cancer, abnormal uterus bleeding, peptic ulcer, the surge in demand for a minimally invasive procedure, and increase in unmet healthcare needs drive the growth of the global endoscopy fluid management market. However, the government's and environmental organizations' proactive actions against pollution restrict the market growth. Moreover, growth & innovations in the medical device industry for the manufacturing of endoscopy fluid management systems present new opportunities in the coming years.

Impact of Covid-19 on Endoscopy Fluid Management Market-

• The outbreak of the Covid-19 pandemic had a negative impact on the global endoscopy fluid management market, as a huge number of clinics and hospitals across the globe were restructured to increase the hospital capacity for patients diagnosed with COVID-19.
• The COVID-19 pandemic has changed the way healthcare providers and medical device manufacturers approach endosurgery fluid management systems. The COVID-19 pandemic affected multiple sub-specialists and procedure-related filed such as gastroenterology.
• A significant proportion of these endoscopic procedures are affected due to national and regional lockdowns across the globe, which in turn, hampered the market growth.

The endoscopy fluid management system segment to maintain its leadership status throughout the forecast period

Based on product, the endoscopy fluid management system segment held the highest market share in 2021, accounting for nearly three-fifths of the global endoscopy fluid management market, and is estimated to maintain its leadership status throughout the forecast period. This is attributed to advancement in technology in healthcare sector, and high cost of endoscopy fluid management system as compared to accessories. However, the endoscopy fluid management accessories segment is projected to manifest the highest CAGR of 7.5% from 2022 to 2031, owing to increase in use of collecting bags, sutures.

The laparoscopy segment to maintain its leadership status throughout the forecast period

Based on application, the laparoscopy segment held the highest market share in 2021, accounting for more than half of the global endoscopy fluid management market, and is estimated to maintain its leadership status throughout the forecast period. This segment is projected to manifest the highest CAGR of 7.6% from 2022 to 2031, due to increase in number of laparoscopy procedure.

The hospitals segment to maintain its lead position during the forecast period

Based on end user, the hospitals segment accounted for the largest share in 2021, contributing to more than two-thirds of the global endoscopy fluid management market, and is projected to maintain its lead position during the forecast period. This segment is expected to portray the largest CAGR of 7.6% from 2022 to 2031, owing to increase in number of endoscopy procedure, development of advanced hospitals and availability of these products at hospitals.

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North America to maintain its dominance by 2031

Based on region, North America held the highest market share in terms of revenue in 2021, accounting for more than one-third of the global endoscopy fluid management market, and is likely to dominate the market during the forecast period. This is attributed to rise in the number of product launch, increase in the number of key players to manufacture endoscopy fluid management system, and development of healthcare infrastructure. However, the Asia-Pacific region is expected to witness the fastest CAGR of 8.0% from 2022 to 2031, owing to increase in prevalence of gastrointestinal disease, and rise in expenditure by government organization to develop the advanced healthcare device.

Leading Market Players: -

• Medtronic PLC
• STERIS PLC
• KARL STORZ SE & Co. KG
• Arthrex Inc.
• B. Braun SE
• Stryker Corporation
• Hologic Inc.
• CONMED Corporation,
• Olympus America Inc.
• COMEG Medical Technologies

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AVENUE- A Subscription-Based Library (Premium on-demand, subscription-based pricing model) Offered by Allied Market Research:

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"We have also published few syndicated market studies in the similar area that might be of your interest. Below are the report title for your reference, considering Impact of Covid-19 Over This Market which will help you to assess aftereffects of pandemic on short-term and long-term growth trends of this market."

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Allied Market Research (AMR) is a full-service market research and business-consulting wing of Allied Analytics LLP based in Portland, Oregon. Allied Market Research provides global enterprises as well as medium and small businesses with unmatched quality of "Market Research Reports" and "Business Intelligence Solutions." AMR has a targeted view to provide business insights and consulting to assist its clients to make strategic business decisions and achieve sustainable growth in their respective market domains. AMR offers its services across 11 industry verticals including Life Sciences, Consumer Goods, Materials & Chemicals, Construction & Manufacturing, Food & Beverages, Energy & Power, Semiconductor & Electronics, Automotive & Transportation, ICT & Media, Aerospace & Defense, and BFSI.

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Marina Lousararian worked in her home country of Argentina as a cardiologist.

Now in B.C. since mid-2021, she cleans schools to make money and is studying hospitality management.

Foreign-trained medical specialists are expressing frustration over how difficult it is to practice in B.C. if they are certified in other countries.

“I graduated as a medical doctor in 2010 from the University of Córdoba,” Lousararian told Global News. “It’s a worldwide recognized university. After that, I started training in cardiology. I became an adult cardiologist in 2016, recognized by the Medical Council of my city, which is Córdoba, and my training was in a military hospital that belongs to the Argentinian Air Force.”

Lousararian passed all her exams to become a doctor and worked for seven years in Argentina.

She said in the last few years there she had three jobs. “I worked for the Argentinian Air Force, and then I worked for another hospital, which is called Privado, and I had my private practice where I performed complementary diagnostic methods for cardiovascular disease like treadmill tests and ambulatory monitoring of blood pressure – studies like that.”

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5:09 Report: Administrative red tape burden on doctors a barrier to patient care

Lousararian said she knew the process of becoming certified in Canada as a cardiologist would be a difficult one as she had heard many stories about other doctors’ experiences.

“I also knew that my medical degree could be recognized here, but not my specialty. So even though I tried to start the process, I found some barriers.”

She said she registered at the Medical Council of Canada while studying hospitality management and she had to pay a fee to do that.

She was then required to upload all of her certifications, which required a fee of $800 – that was only the beginning of a process that is too expensive.

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“After that is when the process starts because to get my certification, or at least to see if I am eligible, I need to take between three or four exams,” she said. “Of course, I need to prove my knowledge and my language proficiency. I know I have to do that, but the process could cost me over $10,000. And of course, I cannot afford that right now.”

2:11 B.C. aims to triple licensing rate of foreign-trained doctors by 2024

Lousararian said that while her medical degree can be approved in Canada, her specialty cannot because the Medical Council of Canada does not consider Argentina a valid training centre.

She said other countries, including Australia, New Zealand and the United Kingdom are approved but many are not.

“I wasn’t going to be able to practice as a cardiologist here because my postgraduate training was not valid,” Lousararian added.

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“So I asked if they could at least consider me as a doctor. It’s not a problem about trying to prove my knowledge because I know I have to prove my knowledge and I know I have to study a lot because this is medicine. We are not talking about things. We are talking about people. And we are willing to prove that we have the knowledge, we have the experience, and we can study as much as we have to study to prove that. But we need the training.”

Last November, the B.C. government announced it is expanding a program that helps internationally educated doctors get licences in B.C.

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This was a move to try and address the dire lack of family doctors within the province.

“The pandemic has exposed underlying challenges and added new strains to our public health-care system, and too many British Columbians are struggling to find a family doctor,” said B.C. Premier David Eby at the time.

“Meanwhile, family doctors trained outside of Canada aren’t able to practise family medicine because they lack a pathway to be licensed here.”

2:13 Doctor says process to get certified in B.C. has taken nearly a decade

Lousararian said she is willing to take the appropriate training but the program announced last year is geared towards family doctors, which she is not.

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“We know that people need specialists here also because they can be waiting for months to get an appointment with a specialist. And some health issues can wait,” she said. “Others cannot wait, especially in my specialty. So it’s really hard and really difficult to see that we are not considered in those programs and patients end up going into an emergency room or maybe they go again to their family doctors, which are already exhausted or retiring because they cannot reach an appointment with a specialist.”

She wants to practice medicine and if that meant changing her specialty, she would do that. But the cost right now is too high.

She would have to take four exams, which she was told would cost $7,500. Then she would have to go through the eligibility process which would cost $4,500 according to the Medical Council of Canada.

“I couldn’t even upload my certification because I am a newcomer, I have to pay my college fees, the rent, and especially when you have kids, you have more expenses. It’s impossible for me to pay $800 just to upload my certifications. I mean, it’s impossible for me today.”

Lousararian said the whole process has left her with mixed feelings.

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“It’s really sad and it’s really frustrating because we know that we can provide a lot of help through our knowledge, through our experience. We can help satisfy the actual health-care needs, but we are still not being considered for that.”

2:11 B.C. aims to triple licensing rate of foreign-trained doctors by 2024

Loicel Aguero is in a similar situation.

He is a trained physician with a specialty in internal medicine.

But he was educated in Venezuela and did his residency in Caracas. He then worked as an internal medicine physician from 2011 until he left to come to Canada four years ago.

Internal medicine physicians treat and diagnose people with internal, complex conditions or problems and then they can also refer patients to a specialist, such as a cardiologist or a gastroenterologist

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“I can treat cirrhosis, cirrhosis hepatic,” Aguero said. “Any kind of pneumonia. I can treat hypertension.”

He said he and his wife left Venezuela due to political upheaval and economic uncertainty.

Since coming to Canada he has been a cleaner, construction worker and unit clerk and is currently a perioperative unit assistant at Richmond Hospital, only starting in January.

He sets up the operating rooms before surgeries.

Aguero wants to become a certified doctor in Canada, but he too is facing financial barriers.

“I think I would need around $10,000 to cover all the things. For example, the MCCQE1 test, I can take it here in British Columbia, and it’s about $1,500 for taking the test.”

Another test he would need costs around $3,500, he said, and it is not even available in B.C. He would have to travel to another province.

“The other thing is you need to have time to prepare yourself for those ones because if you fail the first one, you can repeat that test, but you have to pay it again. But if you pass the test with a lower score, you’re not able to continue your way. You don’t have another opportunity to take again that test.”

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Aguero said he gets frustrated not being able to have an opportunity to practice medicine in Canada.

2:09 Canada’s ER crisis: Doctors urge governments to find solutions for ‘dangerous’ wait times

He would like to see the government supply people from other countries the chance and financial help to become certified in Canada.

“So I think that the government should open courses or programs for international medical graduates to help us. To teach us how the Canadian health-care system works.”

For now, Aguero said he will continue to try to seek accreditation as a doctor in Canada.

“If the door is open, I will enter. I will do it.”

 – with files from Global News’ Paul Johnson

© 2023 Global News, a division of Corus Entertainment Inc.

Not all doctors accept Medicare for the patients they see, an increasingly common occurrence. This can leave you with higher out-of-pocket costs than you anticipated and a tough decision if you really like that doctor.

So what happens when you sign up for Medicare only to learn it's a no-go at your favorite doctor? Fortunately, you have some options.

What's the proper treatment for constant, inexplicable pain in the face, jaw or head that defies conventional dental treatment? According to researchers from the Rutgers School of Dental Medicine, the answer varies widely from patient to patient.

For one patient in a recent case study, it was the removal of a benign tumor in her brainstem.

Those reports are part of a growing body of research from the Rutgers School of Dental Medicine that seeks to document effective strategies for diagnosing and treating a surprisingly common complaint; persistent orofacial pain arising from unknown causes.

"Our research indicates that roughly 10 percent of the population has recurring pain in the teeth, mouth or face that stems from something other than tooth decay or gum problems, and most dentists have little training in diagnosing the problems that cause it," said Gary Heir, study's lead author, who is also the Robert and Susan Carmel Chair in Algesiology and the director of Center for Temporomandibular Disorders and Orofacial Pain at Rutgers School of Dental Medicine.

The patient in the case study suffered years of nearly constant pain in her lower right teeth, jaw and face. She went to a series of dentists, all of whom were baffled because her teeth and gums looked healthy.

A detailed evaluation at the Center for Temporomandibular Disorders and Orofacial Pain diagnosed a benign tumor on the brainstem affecting the primary innervation of the face and jaw. Surgical removal of the tumor resulted in the complete remission of her long-standing pain disorder.

"The diagnostic challenge of these patients requires a significant amount of attention to detail," Heir said. "At the center, we see many patients with these types of presentations that require the advanced investigations offered by the orofacial pain specialists we are training in our program."

The takeaway lies far less in the eventual treatment than the lengthy evaluation by specialists, Heir said. Serious orofacial pain that seems to originate from the teeth or gums often arises from very different causes that range from slight misalignments in the jaw to systemic illnesses such as in this case presented. Successful treatments are equally varied.

Specialists at Rutgers are working to categorize the most common causes of and treatments for unexplained tooth pain that have yet to become part of general dental education. Even when the information spreads, the time needed for the proper diagnosis will prove a challenge for general dentists seeing dozens of patients per day.

"It's definitely a more natural fit for specialists, particularly in academic medicine, because it's time-consuming detective work," Heir said. "Our students often spend two hours or more taking a patient's history, but the history is where the answers lie. Patients will eventually tell you what the problem is. You just need to know what questions to ask and what to listen for."

Compared to the number of patients with orofacial pain, the number of specialists trained to treat them is small. Heir said there are six active Orofacial Pain Diplomates in New Jersey, and four of them teach at Rutgers. Many large swaths of the United States have none at all.

As a result, most ailing patients have difficulty seeking specialists in orofacial pain.

"Right now, patients don't tend to find us until they are desperate," Heir said. "We'd like to get the word out and get them here earlier. No one should suffer for years such as this patient."

© 2023 Benzinga.com. Benzinga does not provide investment advice. All rights reserved.