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Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

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Research Article: Minimally invasive percutaneous cannulated polyaxial screw and rod fixation thoracolumbar and lumbosacral vertebrae: cadaveric evaluation of accuracy and safety of a fluoroscopic-guided technique, in large breed dogs

Date Published: 2026-03-20

Abstract:
To develop and report the accuracy and safety of a technique for percutaneous pedicle screw-rod fixation of the thoracolumbar and lumbosacral regions using fluoroscopic guidance in dog cadavers, comparing two levels of surgical experience. Cadaveric methods comparative study. Cadaveric vertebral columns of dogs ( n =?3). Pre-operative computed tomography (CT) scans facilitated in-silico surgical planning. Ideal implant insertion points and trajectory were recorded, and the image was subsequently reconstructed to mimic the appearance of intra-operative fluoroscopy. After surgical preparation from T8 to S2, the study was divided in two parts: part one to evaluate safety and accuracy of percutaneous “end-on” fluoroscopic drill hole position technique (EOFG); and part two to determinate the feasibility of thoracolumbar (T13-L1) and lumbosacral (L7-S1) percutaneous cannulated pedicle screw and rod fixation (PC-PSRF). The procedures were performed by one of two experienced ECVN diplomates, and one ECVN neurology resident (inexperienced in spinal fixation surgery). Following post-operative CT imaging, drill-hole safety was established using a modified Zdichavsky classification and optimal placement was compared between surgeons. Drill-hole accuracy was calculated based on the deviation from planned angle and bone purchase, between the two levels of surgeon experience. Data sets were analysed at both univariable and multivariable levels with logistic regression analysis. No unsafe holes (0/34) were drilled by experienced surgeons, whereas the inexperienced surgeon drilled 4/34 (11.8%) unsafe holes. Optimal drill-hole placement was significantly associated with surgeon experience ( p <?0.001, OR?=?9.66), whereas cadaver number and spinal region did not reach significance. Drill-hole angle and bone depth deviations were significantly different between experienced and inexperienced surgeons ( p =?0.04 and p <?0.001, respectively). Angle deviations were not significantly different between experience levels by region, whereas mean bone purchase deviations were significantly lower for experienced surgeons in the thoracic region ( p =?0.002), but differences were not significant in the lumbar and sacral regions. The mean time taken to drill the hole was significantly longer for the inexperienced surgeon ( p <?0.001). PC-PSRF using EOFG was successfully demonstrated at T13-L1 and L7-S1. The technique was feasible and allowed for percutaneous fixation of the thoracolumbar and lumbosacral segments. Previous experience in open instrumented spinal surgery is beneficial for safe and accurate application. The PC-PSRF technique using EOFG guidance warrants future clinical studies to investigation a potential role in reducing pain, hospitalisation length, muscle injury and need for surgical revision.

Introduction:
There has been a recent increase in publications concerning minimally invasive surgery (MIS) techniques in veterinary orthopaedics, such as minimally invasive plate osteosynthesis (MIPO) and tarsal arthrodesis (MITA) ( 1 ). In veterinary spinal surgery, MIS has been described for percutaneous decompression of extruded or protrusive intervertebral discs ( 2 ). Percutaneous lateral vertebral body fracture stabilisation using external skeletal fixators has also been described ( 3 ). MIS techniques are expected to…

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