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This week’s topics include dangers of newer oral contraceptives, elevated thyroid hormone and fractures, aflatoxin and gallbladder cancer, and HDL cholesterol efflux and heart disease.

Program notes:

0:34 Newer oral contraceptives and risk of VTE
1:31 VTE and older and newer types
2:32 14 per 10,000 treated
3:10 Aflatoxin exposure and gallbladder cancer
4:11 Compared gallbladder cancer, versus gallstones or no issues
5:14 Too much thyroid hormone and fractures
6:14 Increased fracture risk over 50%
7:11 HDL efflux and heart disease
8:12 Efflux allows excretion
9:11 Independent risk factor
10:12 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/05/29/dangers-of-newer-oral-contraceptives/

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This week’s topics include chest pain in the ED, long term effects of lithium, steroids and sciatica, and new asthma treatment.

Program notes:

0:50  Asthma management
1:50 Modified DNA enzymes
2:31 Lithium and kidney, thyroid and parathyroid
3:31 Increased risk of chronic kidney disease
4:31 Nothing to do with duration of therapy
4:53 Steroids and sciatica
5:53 Acute sciatica and 15 days of prednisone
6:51 More side effects
7:17 Chest pain in the ED
8:17 Very few had adverse events
9:12 Avoid potential of missing something
10:08 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2015/05/22/chest-pain-in-the-ed/

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Anchor lead:  Men with asthma don’t face a higher risk of lethal prostate cancer, Elizabeth Tracey reports

Asthma is known to be driven by inflammation, and inflammation is also a factor in cancer.  But now a Johns Hopkins study has shown that contrary to expectation, men with asthma actually have a lower risk of lethal prostate cancer than men without asthma.  William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says the study reveals yet another complexity to our immune systems.

Nelson: The immune response to infections, the immune response to damaged tissues, the immune response to abnormal cells that arise during the development of cancer, are all very complex with many different cellular components, we’re just beginning to learn them, doing better at controlling autoimmune diseases, better at using immunotherapies to treat cancer, and hopefully better at understanding how the immune system has allowed a cancer to form in the first place.  :28

Nelson says each observation such as this one allows researchers to formulate the next study more precisely as a better picture of the immune system emerges.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Family histories don’t rule when it comes to breast cancer prognosis, Elizabeth Tracey reports

Do women who’ve been diagnosed with breast cancer need to worry about what’s happened to relatives with the disease?  No, a study of several thousand women with premenopausal breast cancer published in the British Journal of Surgery concludes.  William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the data.

Nelson: They looked at women who had a family history of breast and/or ovarian cancer, that was about 15-20% of the total, and asked, were the outcomes in this case, recurrence after surgery, recurrence after surgery and adjuvant hormonal or chemotherapy and radiation, were there differences in the propensity to occur after this kind of treatment, between the groups that had an identifiable family history and the groups that didn’t, and they did not find a difference at all, suggesting that breast cancer is breast cancer, regardless of whether you inherited a tendency to get it.   :32

Nelson says better, targeted treatments may help to explain the observation.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a supplement reduce some skin cancer recurrences? Elizabeth Tracey reports

Skin cancers are very common, and although only melanoma is usually life-threatening, they can require disfiguring surgery and often recur.  Now an Australian study shows that in people who’ve already had one non-melanoma skin cancer, the B vitamin nicotinamide may help.  William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: They were given nicotinamide orally, 500 mg, a reasonable dose, or a placebo.  The folks that had the placebo they had a median of 2.4 skin cancers.  Only about 1.7 or 1.8 if they had taken the nicotinamide.  Also things like actinic keratoses that may be precursors to skin cancer, they were reduced by nicotinamide, so in this reasonably short exposure to this drug that’s pretty easy to take at those doses, there was a reduction in skin cancers.  I’m sure this will need to be reassessed in another similar trial but this is progress.    :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  A team approach may help in pulmonary embolism, Elizabeth Tracey reports.

Pulmonary embolism, abbreviated PE, is when a blood clot forms in the blood vessels to the lung and may be life-threatening.  People with cancer, trauma, those who have been bedridden for some time, may all be susceptible.  Anobel Tamrazi, an interventional radiologist at Johns Hopkins, describes a team approach to this often emergent condition.

Tamrazi: When a PE patient shows up they show up everywhere.  All of a sudden in the emergency room, all of a sudden in the cancer ward, all of a sudden in the ICU, so every team is a little confused, where do we go who do we call? So we form a team.  Anywhere in the hospital you see a patient with big clots, and clinically they look like they’re submassive or massive, you call this number, present the patient and say what’s the best management, and let’s come up with an idea.   :28

Tamrazi says the team will decide the best treatment and implement it, ideally improving outcomes.  He says only a few places nationally are using this approach to PE.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can targeting a single enzyme help both heart failure and arrhythmias?  Elizabeth Tracey reports

Heart failure and disordered beating of the heart known as arrhythmia are killers, but as different as they appear clinically they have an enzyme in common, called caM kinase.  Mark Anderson, director of the department of medicine at Johns Hopkins, says this observation may point the way to effective intervention, known to be successful in animal models.

Anderson: It turns out this particular enzyme, called caM kinase, becomes overactivated by a number of events that happen to occur in people in people with heart failure and arrhythmias.  The story of caM kinase suggests those things happen together because they’re driven by common molecular pathways or processes.  The idea is that by inhibiting caM kinase you could improve the mechanical features of heart failure while quashing the electrical instability that causes arrhythmias and in some unlucky ones, sudden death.   :31

Anderson spoke recently at a media briefing at the National Press Club.  At Johns Hopkins, I’m Elizabeth Tracey.

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