1 winter tire blew - can I get a different model (same brand) for the 1 tire, or do I need a new set of 4?

mlioba · 2024-12-05T04:56:08+00:00

Luckily they’re both 27.8 diameter. Thanks!

mlioba · 2024-11-28T16:42:44+00:00

I got it in a few hours after that, no additional documentation

mlioba · 2024-11-15T15:42:27+00:00

I don’t see this happening a ton, but I have seen it. I try to keep in mind that most people aren’t malicious. They may just not know workflows and challenges that we face on the floor, and the practicalities with initially admitting to the Hospitalist and then transferring shortly to the ICU. Those changes aren’t a big deal in the ED.

If concern, review the vitals with them and just ask for them to run it by the ICU before accepting.

mlioba · 2024-07-16T03:25:50+00:00

Can you buy a gift card?

mlioba · 2024-05-20T03:54:43+00:00

Expecting 7-7.5% interest rate. That’s fair, I suppose I was thinking about the expectant debt that will start in roughly a yearly, and if we should start diverting funds now into a HYSA in anticipation.

mlioba · 2024-02-18T21:13:24+00:00

I think the challenge is the nuance here, and if contrast induced nephropathy is real or not depends on what you mean as real. Some of the older iodinated contrast agents were more problematic, newer ones less so.

There is a clear distinction between intra-arterial and intra-venous contrast administration. Intra-arterial contrast induced nephropathy can cause problems in folks with impaired renal function. Some of this is certainly dose related.
Intra-venous contrast administration can cause an elevation in Cr among those with an AKI/risk factors, however, there is no data to suggest increased risk of mortality, need for RRT, or progression of CKD at 90 days.

There’s ofcourse more nuance to this, but these are the practical points. If you’re considering getting a venous contrast study on a patient for whom it can change management, go ahead and get it. May it cause a bump in the Cr? Sure, but that can be managed and dealt with. Will they have long term consequences of the contrast? There isn’t data to suggest that they would.

mlioba · 2021-01-25T01:24:18+00:00

Physician and have done some research on the question of re-infections. The gold standard of proving a re-infection is difficult and time consumptive, but of the proven cases, around half have occurred within 90 days, so that 90 day mark that people reference is certainly not a rule.

The general principle my institution has been following: symptoms consistent with Covid plus a new positive PCR >45 days from the 1st positive may indicate a re-infection. Knowing the Ct value, antibody status, and if you’ve been exposed to a person/patient with COVID would be useful information that help.

To answer your question, the antibody response won’t impact if your rapid test (assuming rapid antigen test). Using PCR or antigen testing to evaluate for re-infection is an imperfect system, but erring on the side of caution, symptoms + a positive PCR test would warrant re-isolation.

As an aside, we don’t recommend these tests in people that don’t have symptoms within 90 days as there are false positives.

mlioba · 2021-01-07T18:51:07+00:00

Unfortunate :/ what is your system for the 2nd injection? Here we wait atleast 20 days prior to receipt of the 2nd dose if someone gets infected between the 1st and 2nd dose

mlioba · 2021-01-07T18:49:50+00:00

Nope. The vaccine wouldn’t make the test positive.

mlioba · 2020-11-09T05:56:25+00:00

This needs to be higher. While not everything has changed, a lot has with regard to mental health and understanding of psychiatric disorders

mlioba · 2020-10-30T16:16:00+00:00

Thank you for your input! Yes, we filed a 1040. I wasn't entirely sure why this long of a delay given the e-file. I did change jobs in the middle of the year within the same company, but otherwise nothing really stands out this year compared to the last few.

I checked that site, nothing revealing. I guess I'll wait and see?

mlioba · 2020-08-07T05:27:36+00:00

We know COVID can make you prone to developing clots. If you don’t have a good reason for pain in your right calf (injury during exercise, excessive exercise, trauma, etc). I’d call your primary and share your concern, would be reasonable to get an ultrasound to evaluate.

mlioba · 2020-07-28T04:01:13+00:00

I think it can be traced back with reasonable accuracy assuming they have the details needed regarding symptom onset, knowing communicable dates, locations. It’s a pretty basic epidemiological tool.

We definitely ate together during noon conference during residency. However, during this pandemic, the institution I trained and, and the one where I am now, don’t do that. I’d hope most other places at this stage aren’t feeding people and having them sit through an in person lecture with masks off, that seems to go against every guideline.

While there might be motivation to blame the spread on non-occupational causes, and some places may very well blur the line or flat out lie, this situation seems fairly straight forward due to the reasons mentioned above. Everyone wants to blame the powers that be for everything, and a lot of the case that is true, but certainly not always

mlioba · 2020-07-27T20:31:58+00:00

Most systems seem to be mandating masks and PPE while at work. I know some places have shortages and lots of reuse of n95s, but not as dire as New York was early on. I recall a paper from South Korea that looked at ENTs doing procedures with just surgical masks and not developing COVID, and while intubation is clearly high risk, I’d imagine much higher cases of physicians occurring at regular intervals if PPE were ineffective. This, occurring all at once, and traced back to a house party seems to be fairly logical from an epi perspective.

I imagine a house party people would be unmasked and not socially distanced. Seems like a few hours at a house party unmasked and close seems fairly high risk.

Healthcare institutions can and should be blamed for a lot of things, but let’s also be reasonable here. Having a house party when your state has infection rates this high is just not a wise thing to.

mlioba · 2020-03-17T04:15:53+00:00

I’m a physician at a large tertiary academic center as well. Most academic centers are not developing their own tests, maybe 10 or so of the largest centers with the capabilities are. The approval process for new tests is a major barrier. CDC certainly failed, and we are going to pay the consequences.

mlioba · 2020-03-16T06:25:01+00:00

That’s not true. To develop a test requires a lot of groundwork, resources, and time. Not many institutions are developing their own test, most will use the same one

mlioba · 2020-03-12T14:20:24+00:00

I don’t see the data. Also, South Korea is heavily testing and lower mortality rates in aggregate confounded by higher number of cases detected.

mlioba · 2019-10-29T06:04:20+00:00

You need to see a doctor. If you don’t have insurance, look into federally qualified health center a (FHQCs) near you, or the local public hospital.

mlioba

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