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This week’s topics include seafood consumption and Alzheimer’s disease, transcranial stimulation for tinnitus, long term use of marijuana and cognition, and mobile texts for medication adherence.
Program notes:
0:40 Fish and cognition
1:49 Moderate seafood associated with less cognitive deficit
2:41 Only in those with apoE4
3:10 Tinnitus and transcranial stimulation
4:10 Randomized study of 64 subjects
5:10 Welcome addition to possibilities
5:21 Long term marijuana use and midlife cognition
6:21 Adjusted for a number of factors
7:22 Text messages for medication adherence
8:21 Increased adherence rates
9:15 Change things up
10:10 End
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 Anchor lead:  Thyroid function is yet another value that changes as we age, Elizabeth Tracey reports

If you’re an older woman who’s taking thyroid hormone, you may want to talk with your provider.  A study by Jenna Mammen and colleagues at Johns Hopkins suggests that many people are overtreated. What’s known now is that thyroid function changes as we age and needs to be reassessed.

Mammen: What happens to thyroid function during aging?  Up to 25% of women in their 80s will look like they have abnormal thyroid function using standard reference ranges.  There’s a growing body of evidence that some of that what looks like abnormal thyroid function testing may actually be just part of the aging process, and that is not necessarily harmful and in fact may not represent underactive thyroid at all.   :29

Mammen says overtreatment with thyroid hormone can result in negative consequences, such as atrial fibrillation and consequent stroke risk.  She says everyone who is taking thyroid hormone should be assessed at least once a year.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new advocacy program helps find kidney donors, Elizabeth Tracey reports

Living donation, where one person gives up a kidney to someone who needs one, is practical and safe for most.  Now a new program developed by Dorry Segev, a transplant surgeon at Johns Hopkins, and colleagues, is helping to bolster awareness of the need for kidneys for individuals on a transplant list.

Segev: We created a program called the Live Donor Champion program, where people bring their champion with them, we teach them about kidney disease, how to initiate conversations about kidney disease, how to be an advocate.  We teach them about their social network.  And then the champions actually go out and they discuss this and they spread awareness about this.  In our pilot studies we had phenomenal responses to this and impressive transplant rates among the people who participated in this so now we’re offering this to everyone in our center.   :31

Segev says people with kidney disease are often reluctant to talk about it, so the advocates do so on their behalf.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new source of donor organs for people with HIV has become available, Elizabeth Tracey reports

Organs from people who are HIV infected can now be transplanted into others who also have the virus, an initiative spearheaded by Dorry Segev and colleagues at Johns Hopkins has made possible.  Segev says the payoff is potentially huge.

Segev: HIV is actually one of the more common causes of kidney disease today and so there are actually thousands of patients with HIV who have kidney failure who could potentially become kidney recipients.  :13

Previously, perfectly transplantable organs from people who were HIV positive were simply not used, and that, Segev says, was a big waste of resources.

Segev: When we were writing the HOPE act, we were estimating that there are probably about three hundred to five hundred viable donors every year that are discarded because they’re HIV positive.  So we would expect on the order of a thousand or more organs to be available for transplant.  :19

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Even those who are HIV positive can be organ donors, Elizabeth Tracey reports

People infected with HIV have historically been unable to be organ donors, but now a new initiative spearheaded by Dorry Segev and colleagues at Johns Hopkins has changed that.  Suitable organs for transplant from those who are HIV positive can now be transplanted into recipients who also have HIV.

Segev: What we’re trying to do is help patients with HIV get transplanted. There is a potential pool of donors out there who have HIV.  Obviously those organs can’t go into somebody who doesn’t have HIV but we’re going to use those organs and put them into somebody who has HIV.  If you have HIV and you’re on an organ transplant list your likelihood of dying is very very high without a transplant.  So it’s particularly important to get these patients transplanted, and there is a potentially novel source of organs for them.  :33

Segev expects the first HIV to HIV transplant to take place soon.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: An uncommon condition that used to require surgery can now be managed medically, Elizabeth Tracey reports

Retroperitoneal fibrosis is the tongue-twisting name of an inflammatory condition that ultimately constricts urine flow, resulting in pain and other symptoms.  Paul Scheel, a kidney expert at Johns Hopkins, and colleagues, have developed a way to treat it that doesn’t involve surgery.

Scheel: Retroperitoneal fibrosis is inflammation and fibrosis that occurs around the aorta below the level of the renal vessels. It’s very common for patients to present with weight loss, pain, and a number of other vague symptoms and undergo diagnostic workup for up to two years before a diagnosis is finally reached.   Historically retroperitoneal fibrosis was treated surgically. In our initial regimen we chose prednisone 40 mg to start with 10 mg to taper per month, and we added mycophenolate or CellCept as a steroid sparing agent initially.  What was later discovered was that CellCept has antifibrotic properties.   :35

Scheel says the regimen is gaining attention for other autoimmune conditions where fibrosis results.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include a Zika virus update, choice of topical agents before C-section, surgery resident hours, and rivaroxaban trial questions.

Program notes:

0:33 Zika virus update
1:34 Transmission probably through semen
2:33 Modification of surgical resident hours
3:34 More flexible policy studied
4:30 Less likely to leave an operation
4:44 Topical agents for skin before C-section
5:44 Randomized over 1100 patients
6:40 Rivaroxaban trial
7:40 Often used as preferred agent
8:42 Authors published another analysis
9:33 Newer agents still need monitoring
10:10 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2016/02/05/skin-disinfection-agents/

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