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This week's topics include chlorhexidine baths in the ICU, dangers of too much sitting, intracytoplasmic sperm injection, and stem cell therapy for MS

Program notes:

0:40 Intracytoplasmic sperm injection
1:36 Outcomes no better
2:32 Bathing patients with chlorhexidine in the ICU
3:32 Randomized by ICU and crossover
4:32 Visitors wash hands too
4:44 Stem cells and MS
5:44 Administered own stem cells
6:40 Not randomized or controlled
7:24 Deleterious effect of sitting
8:24 All-cause mortality increased
9:24 Standing meetings
10:21 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/01/23/stop-sitting-around/

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Anchor lead: Eating more whole grains helps reduce mortality risk, Elizabeth Tracey reports

It’s confirmed: a recent analysis of two very large, long term studies has shown once again that the more whole grains you consume, the more you reduce your risk of death.  Redonda Miller, an internal medicine expert at Johns Hopkins, takes a look at the data.

Miller: They looked at quintiles of dietary whole grain intake and impact on total mortality, cancer mortality and cardiovascular disease mortality.  What they found was that for both total mortality and cardiovascular mortality, the higher the quintile of whole grain intake the lower the risk of death. They did not see a relationship between cancer mortality and whole grain intake.   :26

Miller says it’s not clear why cancer mortality is unaffected by whole grain consumption, but notes that eating more such products is simply a matter of substituting whole grain for refined cereals, breads, pasta and the like, and is also helpful in weight control.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Can you be fit even if you’re fat? Elizabeth Tracey reports

Obese people sometimes argue that even though they’re overweight, they work out and they’re healthy.  Now a research letter in the journal Circulation seems to dispel that notion.  Redonda Miller, an internal medicine expert at Johns Hopkins, describes the research.

Miller: The investigators defined obese as a BMI over thirty, and defined quote “healthy” as having less than two risk factors. And the risk factors included things such as low HDL, high LDL, diabetes markers, high blood pressure.  At five years 31.8% had become unhealthy, meaning they had two or more of these risk factors.  At ten years even higher and at 20 years over half of them at 51.5%.    :27

Miller says other deleterious consequences of obesity, such as knee osteoarthritis, back problems, or an increased risk of certain cancers, were not addressed in this study but certainly argue for continued weight loss efforts for those who are overweight.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A multitude of factors need to be considered to overcome obesity, Elizabeth Tracey reports

Both obese men and women benefit from bariatric surgery, a recent study found, and that fact alone may encourage more people to undergo surgery.  But Kimberly Steele, a bariatric surgeon at Johns Hopkins, says a comprehensive look at many factors is the most likely route to success in treating obesity over the long haul.

Steele: I have patients who come to me and they will say, after surgery, I know that my stomach is full but my brain is telling me I’m hungry.  Is it psychiatric?  Well, I think there’s something happening in the brain. Is it genetic?  I think there’s a part that is genetic.  Is it conditioning? Being a part of a society where more is better?  Yes.  Is it cultural? Yes.  So I think it is a combination of multiple factors, we have to tap into those and figure it out.   :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Are permanent or reversible techniques better for weight loss surgery? Elizabeth Tracey reports

Surgical techniques for achieving weight loss keep being developed, and if you’re considering such surgery, especially as studies continue to show benefit, which is best?  Kimberly Steele, a bariatric surgeon at Johns Hopkins, says while reversible techniques may seem attractive, so far they don’t appear to work as well.

Steele: These things might be reversible like the laparoscopic adjustable gastric band, except maybe there needs to be a physiologic change like when you do a gastric bypass on a patient, which actually does do something physiologic immediately.  There might need to be a balance between the two. And certainly we’re doing a lot of research here at our center and we’re trying to come up with new and novel ways to address obesity, how to prevent it and how to hopefully cure it.   :30

Steele says for now, tried and true as well as choosing a center with abundant experience is likely best.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Obese men and women benefit from bariatric surgery, Elizabeth Tracey reports

Obese men as well as obese women benefit from bariatric or weight reduction surgery, a recent study finds.  Kimberly Steele, a bariatric surgeon at Johns Hopkins, applauds this study focused on overweight men.

Steele:  It certainly is reassuring to show that bariatric surgery is safe and effective and it does have substantial benefit to the obese patient. It extends the findings to another population. In most of the studies that have been done up until this point there has been a female population and that’s because overall, we see about 80% women and 20% men.  This study, having been done at the VA, looks at a larger cohort of male patients.   :31

Steele notes that safety has improved considerably since bariatric surgery has been more widely undertaken and is now usually done laparoscopically.  She points out that with some operations, people who also have diabetes can expect immediate improvement.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Screening for cervical cancer will now consist largely of HPV screening, Elizabeth Tracey reports

Women in the US are accustomed to having a Pap smear to assess their risk of cervical cancer.  Now new guidelines employ testing for the HPV virus instead for most, with those women whose results are negative not recommended for retesting for three years.  Connie Trimble, an HPV expert at Johns Hopkins, says there is an upside to this strategy.

Trimble: One of the reasons it’s really good is that it’s completely objective, and persistent HPV infection is the proximate cause of disease, it’s the biggest identifiable risk factor, so if you can identify people who are at really, really low risk to get disease that’s a good thing.   :17

Trimble emphasizes that these guidelines are still under development, however.

Trimble: The purpose of a screen is to identify people at risk.  Sure, persistent HPV infection those are people who are more at risk but if we could develop some more quantitative additional algorithms I think that would be more useful.   :14

At Johns Hopkins, I’m Elizabeth Tracey.

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