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Convalescent plasma, which is donated by someone who’s had Covid-19 and survived, is a much more reliable treatment for infection today than it was early in the pandemic. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, explains why.

Casadevall: We lucked out in that now we can get extremely high titer plasma, something that did not exist in 2020. Why? Because people like myself, who’ve been vaccinated and then get Covid mount enormous antibody responses. So the quality of the plasma today is significantly better than anything that we ever used in the past. So you have better plasma, and you have need, and convalescent plasma is back. It’s also been documented that if you use monoclonals, which bind only to a single piece, that you select for monoclonal resistant variants.  :33 

Casadevall says people who are immunocompromised are the best candidates for convalescent plasma treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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Early on in the pandemic plasma collected from people who’d had Covid-19 and survived, so called convalescent plasma, was used to treat others, with mixed success. Now that new variants have emerged that can escape antibodies stimulated by vaccines and most monoclonals aren’t useful, Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, says the treatment is being used again.

Casadevall: it’s now very clear that immunosuppressed individuals are not clearing this. it becomes chronic. It interferes with the rest of their therapy, and then the monoclonals are not there, Paxlovid has a lot of drug drug interactions, so then plasma finds a role. Plasma is being used today at Hopkins and Mayo largely as replacement therapy. Because people with B cell defects don’t make antibody and they are being treated with this, and the results are good, I mean people clear the infection when they are given plasma.  :31

Casadevall says the plasma requires intravenous administration. At Johns Hopkins, I’m Elizabeth Tracey.

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Apps to help people manage health conditions are getting more and more sophisticated, with some studies showing they reduce hospitalizations and slow down disease progression. Cardiologist Seth Martin at Johns Hopkins and developer of one such app says use of these apps compares favorably with clinically focused approaches.

Martin: Even if it’s as good but we can increase access to care to people who can’t currently access existing clinical care because of various barriers like cost, or transportation, that’s still a big win. But I think we have the potential to both increase access to care and also take current care to another level because we’re able to use algorithms and send coaching messages through the app. I think we can both scale up existing care and improve it in the long term.  :30

Martin notes that as smart phones become more ubiquitous and privacy concerns are put to rest, more and more of us will be using such apps to manage our health. At Johns Hopkins, I’m Elizabeth Tracey.

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We know that reducing LDL cholesterol, often by using a statin, helps reduce someone’s heart disease risk. Now that so-called ‘remnant cholesterol’ is being added to the calculations, what can be done about it? Johns Hopkins cardiologist Seth Martin says, not much at this point.

Martin: When we think about what we can do in preventive cardiology to help people, prevent heart attacks, prevent strokes, prevent mortality, so much of our evidence is around LDL cholesterol. When it comes to remnant cholesterol or triglycerides it’s still an area that we don’t have as much evidence around what we can do to help. With LDL cholesterol we have in addition to diet and exercise have statins, we’ve had a number of therapies  come out that show a benefit. We don’t have that same level of evidence for remnant cholesterol so it’s an emerging risk factor, but then the next question is well what can we do about that risk?  :34

Martin says it may still be helpful to know the numbers, however. At Johns Hopkins, I’m Elizabeth Tracey.

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You’ve probably already heard about total cholesterol and its cousins HDL and LDL, especially if you see a cardiologist. Now a new term called remnant cholesterol is entering the conversation, with a recent study concluding that it can increase accuracy in predicting heart disease risk. Seth Martin, a cardiologist at Johns Hopkins, explains.

Martin: This term ‘remnant cholesterol,’ has been used to basically capture the risk associated with triglyceride rich remnant lipoprotein. Another circulating substance that’s bad is triglycerides or blood fats. One way to capture the risk associated with them is remnant cholesterol. So this is very closely tied to triglyceride levels, but this is a new way of looking at things. The idea here is to take non-HDL and then subtract LDL cholesterol    :31

Martin says some people may already be seeing remnant cholesterol in their lab results. At Johns Hopkins, I’m Elizabeth Tracey.

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People who were obese who had bariatric surgery developed about half the number of cancers ten years later than did obese people who didn’t have the surgery, a recent study found. Kimmel Cancer Center director William Nelson at Johns Hopkins says questions remain.

Nelson: It hints that perhaps weight control might affect the propensity to develop cancer. If you cared enough about your weight to undergo an operation, one argument is that you care enough about the rest of your health to not smoke, to pursue appropriate aged cancer screening, to get blood pressure controlled, to make sure your blood sugar was better controlled, and all of those things could explain the reduced cancer risk. With that caveat it’s interesting, it’s not proven.  :28

Nelson says it is known that bariatric surgery improves diabetes and cardiovascular disease risk and that there is an association between obesity and some types of cancer, but further research is needed to establish a link with surgery and reduced cancer risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Obesity is known to increase cancer risk, so if someone who is very overweight has bariatric surgery, does their risk for cancer decline? Kimmel Cancer Center director William Nelson at Johns Hopkins describes a new study that examines this question.

Nelson: They looked at folks who had undergone bariatric surgery and they matched them up to five fold the number of people who were also obese who didn’t have the surgery. They then went and looked at how many people got cancers that could reasonably be ascribed to obesity as a causative risk factor. Thirteen kinds of cancer. By ten years after the surgery 2.9% of the folks had developed cancer, after surgery as compared to 4.8% if you didn’t have the surgery.   :30

Nelson notes that deaths from cancer among people who were obese followed a similar pattern, with those who had had bariatric surgery experiencing fewer cancer deaths. He says these results must be confirmed however before bariatric surgery can be recommended for this purpose. At Johns Hopkins, I’m Elizabeth Tracey.