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This week’s topics include a new drug for MDR TB, concussion in adolescent girls, cancer screening in the elderly, and smoking cessation after hospital discharge.

Program notes:

0:35 Cancer screening in the elderly
1:35 31 to 55% of high mortality risk still screened
2:35 Patient education time consumption
3:04 Smoking cessation after hospitalization
4:04 Six months of phone calls after discharge
5:02 In motivated patients
5:15 Concussion in adolescent girls
6:15 Symptoms could last seven to 15 days
7:15 Helmet use?
8:06 MDR TB and a new drug
9:07 Both clearing and cure improved
10:27 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2014/08/23/hey-girls-how-about-a-concussion/

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Anchor lead:  A strategy to stop blood flow to the stomach and treat obesity is well-founded in other treatments, Elizabeth Tracey reports

BEAT Obesity is a clinical trial underway at Johns Hopkins to stop blood flow to an area of the stomach that produces hormones important in appetite and eating behavior.  Clifford Weiss, principal investigator of the trial and an interventional radiologist, says while the application is new, the technique is not.

Weiss:  Embolization is a really common interventional radiology procedure. Not only is it used if someone came in bleeding, but we also use it for cancer treatment or for fibroids.  These are patients with solid muscle tumors that are benign in their uterus, and we actually embolize the arteries that feed those.  So embolization is a bread and butter technique, a standard technique for interventional radiology.  When I talk to a patient about what I do I say I either close blood vessels or I open blood vessels.  This is a way we close blood vessels.       :27

Previous work in animal models has shown that embolization of the arteries that supply this part of the stomach is safe.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a new technique less invasively treat obesity?  Elizabeth Tracey reports

Using nothing more than a catheter and tiny plastic beads, Clifford Weiss and colleagues at Johns Hopkins are investigating a new treatment for obesity called the BEAT Obesity trial.  Weiss describes the intervention.

Weiss:  We actually select the artery that feeds the top of the stomach, and in this area of the stomach we know the hormone producing cells of a particular hormone called ghrelin, which stimulates food intake, so we would actually put a catheter into the artery that feeds this, this little plastic tube into the artery that feeds the top of the stomach, and then deliver very carefully small little particle embolics, little plastic particles and they block the blood vessels.  And that should downregulate these hormones and have patients actually not be hungry.  :27

Weiss says the treatment is not for everyone; patients must not have diabetes, cancer, or other medical conditions, but he’s hopeful that this fairly noninvasive strategy could help people lose weight.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  The FDA has just approved a new test for colorectal cancer screening, Elizabeth Tracey reports

Colorectal cancer screening has for years relied on physical examination of the large intestine most often using colonoscopy in the US but also using sigmoidoscopy worldwide.  Now the FDA has approved a new, noninvasive screening tool, Patrick Okolo, a colorectal cancer expert at Johns Hopkins, describes.

Okolo: This is a test that’s been recently approved by the FDA and relies on the detection of DNA and DNA mutations to identify the presence of advanced polyps and colorectal cancers.  And this is quite accurate in doing so.  If the test is positive there’s a lesion there, but it may not pick up all lesions.  And so the FDA has looked at it and done a very good job in saying this is a good adjunct but does not change the paradigm at the moment.  I think this is only the beginning in a shift in the way that we look at things.   :33

Okolo predicts a range of options becoming available soon that will screen for colorectal cancer based on a stool sample.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Should you have a sigmoidoscopy rather than a colonoscopy? Elizabeth Tracey reports

There’s no question that examination of the large intestine, either using colonoscopy or sigmoidoscopy, reduces both the incidence of and death relative to colon cancer.  Now a very large, prospective study has shown that sigmoidoscopy may reduce deaths by 25%, so should you simply opt for this technique rather that the more exhaustive colonoscopy?  Patrick Okolo, a colon cancer expert at Johns Hopkins, offers his opinion.

Okolo:  We clearly know that this is not a waste of your time, and that if you cannot get a colonoscopy, at least get a flexible sigmoidoscopy and you get significant bang for your buck. The question still remains as to whether colonoscopy is superior to flexible sigmoidoscopy in an American population.  Sigmoidoscopy is still a significant tool in reducing both colorectal cancer and colorectal cancer related death.  :25

Okolo recommends talking with your physician about the options.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Sigmoidoscopy definitely helps reduce colorectal cancer deaths, Elizabeth Tracey reports

Flexible sigmoidscopy, where a much smaller and more accessible part of the large intestine is examined compared to colonoscopy, has a very positive impact on reducing both colorectal cancer and death from the disease, a recent large study reports.  Patrick Okolo, a colorectal cancer expert at Johns Hopkins, explains the data.

Okolo:  This is the highest level of evidence, this is a randomized clinical trial, and in this randomized clinical trial, multiple patients representing patients and years of clinical experience and years of exposure, were randomized to flexible sigmoidoscopy, with and without occult blood testing.  Things that we thought that we’d left behind in America.  The results were quite interesting.  It showed an over 25% reduction in death from colorectal cancer.   :25

The technique also doesn’t require sedation although preparation of the large intestine just as for colonoscopy is still necessary.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include salt and hypertension, Chikungunya in the US, flexible sigmoidoscopy and colorectal cancer, and BMI and cancer.

Program notes:

0:35 Exhaustive studies on salt and high blood pressure
1:35 Salt intake, cardiovascular disease and mortality
2:35 Natural history of blood pressure?
3:31 Appropriate intervention?
4:34 Chikagunya virus in the US
5:35 Control standing water
6:27 Insect repellant throughout the day needed
7:05 Benefit of colon examination
8:08 Groups recommending different things
8:30 BMI and cancer mortality
9:30 Another reason to control weight
10:26 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2014/08/15/chikungunya-virus-and-you/

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