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This week’s topics include citrus and melanoma, a new oral medication for obesity, stroke treatment guidelines, and a vaccine for Helicobacter pylori.

Program notes:

0:40 Consumption of citrus and melanoma
1:40 Citrus source of photosensitizing chemicals
2:41 Is it across all citrus fruits?
3:30 Vaccine for H.pylorii
4:32 Got an oral vaccine with a lot of protein
5:31 No serious side effects
6:00 Oral agent for obesity
7:01 About 2/3 lost at least 5% of body weight
8:02 Stroke treatment update
9:01 Certain patients suitable
10:01 Published in Stroke
10:51 End

related blog:

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This week’s topics include DVT and cancer, benefits of marijuana, bridging anticoagulation in afib patients, and reversing dabigatran.

Program notes:

0:35 Analysis of medical marijuana benefits
1:35 Nausea and vomiting due to chemo
2:31 Legalized in 23 states and DC
3:35 Reversing legalization unlikely
3:51 Reversing dabigatran
4:54 An antibody toward saw target as medicine
5:59 In patients with afib and anticoagulation?
7:00 Very small risk of clot
7:30 Unprovoked DVT and cancer
8:30 Randomized to routine screening or CT
9:20 Why do I have a DVT?
10:05 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/06/26/medical-marijuana/

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Anchor lead:  Can appendicitis be treated with antibiotics? Elizabeth Tracey reports

Acute appendicitis has been treated as a surgical emergency for decades now, with largely good outcomes.  But is surgery really necessary or can antibiotics be used instead?  That was the question addressed in a recently published study described by Redonda Miller, an internal medicine expert at Johns Hopkins.

Miller: They did a randomized controlled trial, 530 patients with uncomplicated acute appendicitis by CT, and randomized them to antibiotic therapy for 10 days, versus appendectomy straight off.  What they found was that the 273 randomized to surgery all successful but one, and then the 256 who received the 10 days of antibiotics, 186, which is 72.7%, did fine.  None of the 20-some percent who ultimately required surgical intervention, had a bad outcome.   :33

Miller says additional research should help determine whether for most, antibiotics can cure appendicitis.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can for-profit corporations partner with public health interventions internationally? Elizabeth Tracey reports

Can UPS help the UN in international humanitarian relief efforts, as announced recently?  Can Coca-Cola distribute lifesaving rehydration drinks?  William Greenough, an oral rehydration expert at Johns Hopkins, examines the issues surrounding corporate involvement in public health.

Greenough: The people who are marketing for profit around the world, their agenda is to make money for the company.  I think the risk is we have no real power or grip on the people who are marketing or the people who are developing new product.  The risk is they might want to modify the formula, no question the distribution chains among S corporations are wonderful, and the question is will they adopt things that are really useful for health or will they continue to market things that may not be so useful for health.     :28

Greenough concludes that the potential for benefit is so great the risk in partnering with multinational corporations is worth it.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Is there any benefit to aggressively lowering blood glucose in people with diabetes?  Elizabeth Tracey reports

How low should blood sugar go to control the many consequences of diabetes, especially cardiovascular problems?  For many years the thought was the tighter the control the better, but now a decade of data offers a contrary view.  Rita Kalyani, a diabetes expert at Johns Hopkins, describes the research.

Kalyani: At the end of an average of ten years of follow up the intensive group had a significantly lower risk of a major cardiovascular event, it was reduced by about 17% but they did not have a significant reduction in cardiovascular mortality or total mortality. What these results suggest is that there was a persistence of that initial intensive glucose lowering, what we call metabolic memory, that persisted even after the intensive treatment was discontinued, even after 10 years.   :30

Kalyani says this study underscores the need to take a personalized approach to blood sugar control in those with diabetes, taking into account other conditions and medications to maximize benefit.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  There’s hope for people with one type of lung cancer, Elizabeth Tracey reports

About one-third of people with lung cancer have a type known as squamous cell, and for these patients, an antibody called nivolumab has been shown to help a lot.  That’s according to research by Julie Brahmer, a lung cancer expert at Johns Hopkins, and colleagues.

Brahmer: This is the first time an immunotherapy has shown a survival advantage compared to chemotherapy.  Patients with squamous cell histology that had metastatic disease, nivolamab consistently showed an increased response rate, as well as increased overall survival, and the duration of response lasted much longer with nivolamab compared to docetaxel, so that has led to the approval of this antibody for patients with squamous cell histology.    :30

Brahmer says nivolumab can now be considered as part of the strategy for treating lung cancer, along with surgery, chemotherapy, and radiation.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Control comes in two forms, and impacts your mental health, Elizabeth Tracey reports

If you have the ability to directly change a situation, that’s primary control.  If you can change how you respond to a situation, that’s secondary control.  Now research by Erik Helzer, a behavior expert at Johns Hopkins, and colleagues, shows that for most, secondary control has a bigger impact on life satisfaction, with many organizations taking note.

Helzer: There’s an uptick in the number of organizations that are teaching for example, mindfulness interventions, or that are doing stress reduction kinds of interventions.  I think one of the ways that these strategies are successful is in increasing people’s mental flexibility to appraise situations, to learn from them, to not just react and want to change them immediately, and all of those things fall under that broad umbrella I think of secondary control.   :26

Helzer says both types of control matter, and cultivating the ability to both make decisions and set goals, and be flexible when roadblocks appear, are important life skills.  At Johns Hopkins, I’m Elizabeth Tracey.

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