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This week’s topics include peanuts and allergy, pregnancy after bariatric surgery, NSAIDs and heart disease, and foods and bugs that cause illness.

Program notes:

0:35 Peanuts as baby food?
1:35 640 infants to peanut exposure or not
2:35 A specific case of the hygiene hypothesis?
3:26 First exposure in presence of physician
4:10 NSAIDs after heart attack
5:10 A third ended up on an NSAID
6:09 Pregnancy after bariatric surgery
7:09 Less likely to have big babies
7:38 Foods and bugs and illness
8:40 E. coli infected beef and raw vegetables
9:31 Target information to at risk groups
10:18 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2015/02/28/peanuts-as-baby-food/

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Anchor lead: How many medicines can someone with chronic fatigue syndrome or severe exercise intolerance disease expect to take?  Elizabeth Tracey reports

Systemic exercise intolerance disease or SEID is the new name for chronic fatigue syndrome, and it is thought to affect between 800,000 to a couple of million people in the US alone.  Because there are a wide range of symptoms, Peter Rowe, an SEID expert at Johns Hopkins, says a range of treatments may also be needed.

Rowe: We often need to treat people with more than one medication and we call that rational polypharmacy.  For many of these patients with SEID and CFS, there’s an overlap of a lot of other comorbid conditions, and so they need to be treated and one of the effective ways to treat them is to peel each one away and keep encouraging improvement in their exercise and activity level and you see improvements over time with that approach.  :27

Rowe says for people who are already disabled and housebound by SEID, about 25% of people with the condition, multiple treatments and prolonged duration may still not bring results, pointing to the need for more research into the cause of the condition.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: There is evidence from testing to help make the diagnosis of chronic fatigue syndrome or systemic exercise intolerance disease, Elizabeth Tracey reports

If you suspect you have chronic fatigue syndrome, newly renamed SEID or systemic exercise intolerance disease, how is the diagnosis made?  Peter Rowe, an SEID expert at Johns Hopkins and one member of a recent Institute of Medicine panel on the condition, describes the criteria.

Rowe: People with CFS, when they’re tested on consecutive days using a cardiopulmonary exercise test have a drop off in their exercise capability not related to effort, and that’s very different from any other disease including just simple deconditioning.  The three main things you need to have: reduction in your activity level, post-exertional malaise and unrefreshing sleep.  In addition you can either have cognitive dysfunction or orthostatic intolerance.   :27

Orthostatic intolerance refers to someone’s inability to stand or even be seated for a long period of time. Rowe says in children and teenagers, this symptom may show up as reluctance to go to the mall, a sure sign of trouble in this population.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  What’s behind a recent name change for chronic fatigue syndrome? Elizabeth Tracey reports

Chronic fatigue syndrome, abbreviated by some providers as CFS, has been renamed by no less an august body than the Institute of Medicine, at the request of various federal agencies.  Now abbreviated SEID, for systemic exercise intolerance disease, the hope is that more people will become aware of the condition.  Peter Rowe, an SEID expert at Johns Hopkins, who helped craft the new name, describes the reasoning.

Rowe: What are the key features of this illness?  One of them was a profound reduction in the person’s ability to do what they had done before. With that most people had what had been termed ‘post exertional malaise’ which is a bit of a cumbersome term but it refers to the fact that if you exceed your limits of activity you will get two or three days of amplification of all of your symptoms. Much worse exhaustion, terrific difficulty with cognitive fogginess, lightheadedness, pain is worse, people just feel awful.   :30

Rowe hopes the new name is more reflective of the reality of the condition.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:   A recent superbug outbreak can be controlled, Elizabeth Tracey reports

CRE stays for carbapenam resistant enterbacteriaceae, and this is the bug that colonized one type of endoscope at a California hospital, killing two people and perhaps infecting scores of others.  While such a prospect is frightening, Patrick Okolo, chief of endoscopy at Johns Hopkins, says procedures are in place to disinfect the instruments and make sure that’s effective.

Okolo: As a backup surveillance mechanism we are also looking at these endoscopes, culturing them to make sure that they are free of these superbugs. We do anywhere from 500,000 to a million of these procedures in the United States.  They’ve been something in the region of a hundred and thirty cases or so and unfortunately two deaths have been linked to this bug via this mechanism.  The numbers are small, the procedures are often serious procedures for serious indications so I think for those who’ve had this procedure they ought not to worry.   :34

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Do you need to be concerned about superbugs and endoscopes?  Elizabeth Tracey reports

A type of bacteria known to be resistant to virtually every antibiotic we have was revealed to have been present on an instrument known as an endoscope at a California hospital.  Patrick Okolo, chief of endoscopy at Johns Hopkins, explains what is known.

Okolo: The contamination of endoscopes has been localized to the duodenoscope, one of the many types of endoscopes that we use, primarily for procedures for the bowel and the pancreatic ducts.  They are different from colonoscopies and different from gastroscopes which most people would be more familiar with.     :19

Okolo says the architecture of the instrument is the culprit.

Okolo: This particular endoscope has small moving parts that may not be cleaned properly just using the standard procedures. We now know that the procedures we should use for cleaning these endoscopes need to go far beyond the manufacturer’s requirement.   :15

Okolo says much more rigorous decontamination procedures are in place and people who need to have these procedures can feel confident.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include Fusobacterium pharyngitis, steroids in pneumonia, electric fans and overheating, and varenicline for smoking cessation in reluctant patients.

Program notes:

0:34 Reluctant smokers
1:35 Year long large study
2:32 Vast majority of people did well
3:28 Electric fans and overheating
4:34 Use of fan prevented much heat related problems
5:18 Steroids in pneumonia
6:18 Less likely to have chest x-ray progression
7:18 Subpopulations among patients with pneumonia
8:03 Fusobacteria and sore throat
9:02 In this age group may be more common
10:28 End

Related blog:

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