General Medicine and Primary Care

Host: Matt Birnholz, MD

Today’s culture of stress is driving people to pharmaceuticals and other dangerous outlets as coping mechanisms. What strategies should people employ to mitigate stress and manage their time better?

Host Dr. Matt Birnholz sits down with Dr. Patricia Sulak, Endowed Professor at Texas A&M University to talk about the dangers of stress.

Host: Matt Birnholz, MD

Psychiatry gets a bad rep for being one of the more "technophobic" fields in clinical medicine. This negative association stems in part to the difficulty in tracking changes in mood, cognition, and certain behaviors over time. But there is a growing contingency of psychiatric clinicians who are bringing technology into this specialty to help propel standards in mental health care.

Dr. Adam Kaplin, Assistant Professor of Psychiatry at Johns Hopkins School of Medicine and Principle Psyciatric Consultant to the Johns Hopkins Multiple Sclerosis and Transverse Myelitis Centers of Excellence, joins Dr. Jennifer Caudle to discuss ways in which technological innovations can enhance psychiatric care and decrease stigma surrounding mental illness.

A phase 3, multi-center, multinational, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of levofloxacin inhalation solution (APT-1026) in stable cystic fibrosis patients. Flume PA, VanDevanter DR, Morgan EE, Dudley MN, Loutit JS, Bell SC, Kerem E, Fischer R, Smyth AR, Aaron SD, Conrad D, Geller DE,Elborn JS.

J Cyst Fibros. 2016 Jul;15(4):495-502. doi: 10.1016/j.jcf.2015.12.004. Epub 2016 Feb 4.

Abstract

RATIONALE:

For patients with cystic fibrosis (CF), the use of inhaled antibiotics has become standard of care to suppress chronic Pseudomonas airways infection. There are limited antibiotic options formulated and approved for inhaled use and antibiotic efficacies attenuate over time, making additional inhaled antibiotic classes desirable. APT-1026 (levofloxacin inhalation solution, LIS) is a fluoroquinolone in development for management of chronic P. aeruginosa airways infection in patients with CF.

OBJECTIVES:

To compare the safety and efficacy of a 28-day course of treatment with LIS 240mg or placebo BID in persons ≥12years old with CF and chronic P. aeruginosa infection.

METHODS:

A multinational, randomized (2:1), double-blinded study of LIS and placebo over 28days in CF patients ≥12years with chronic P. aeruginosa infection. Time to exacerbation was the primary endpoint. FEV1 (% predicted) and patient-reported …

Host: Jennifer Caudle, DO

Guest: Joseph Berger, MD, FACP, FAAN, FANA

Multiple sclerosis is a notoriously difficult disease to diagnose early on. With no singular confirmatory tests yet available, physicians often become reluctant to identify MS in their patients, leading to years of diagnostic and treatment uncertainty. But new innovations are helping doctors establish earlier diagnoses and start more targeted treatments for MS patients.

Dr. Jennifer Caudle welcomes Dr. Joseph Berger, Professor of Neurology at Penn Medicine, to explore some of these innovations advancing MS diagnosis and treatment.

A novel treatment of cystic fibrosis acting on-target: cysteamine plus epigallocatechin gallate for the autophagy-dependent rescue of class II-mutated CFTR.

Tosco A, De Gregorio F, Esposito S, De Stefano D, Sana I, Ferrari E, Sepe A, Salvadori L, Buonpensiero P, Di Pasqua A, Grassia R, Leone CA,Guido S, De Rosa G, Lusa S, Bona G, Stoll G, Maiuri MC, Mehta A, Kroemer G, Maiuri L, Raia V.

Cell Death Differ. 2016 Aug;23(8):1380-93. doi: 10.1038/cdd.2016.22. Epub 2016 Apr 1.

Abstract
We previously reported that the combination of two safe proteostasis regulators, cysteamine andepigallocatechin gallate (EGCG), can be used to improve deficient expression of the cystic fibrosistransmembrane conductance regulator (CFTR) in patients homozygous for the CFTR Phe508del mutation. Here we provide the proof-of-concept that this combination treatment restored CFTR function and reduced lung inflammation (P<0.001) in Phe508del/Phe508del or Phe508del/null-Cftr (but not in Cftr-null mice), provided that such mice were autophagy-competent. Primary nasal cells from patients bearing different class II CFTR mutations, either in homozygous or compound heterozygous form, responded to the treatment in vitro. We assessed individual responses to cysteamine plus EGCG in a single-centre, open-label phase-2 trial. The combination treatment decreased sweat chloride from baseline, increased both CFTR …

Microbial colonization and lung function in adolescents with cystic fibrosis. Hector A, Kirn T, Ralhan A, Graepler-Mainka U, Berenbrinker S, Riethmueller J, Hogardt M, Wagner M, Pfleger A, Autenrieth I, Kappler M, Griese M, Eber E, Martus P, Hartl D.

J Cyst Fibros. 2016 May;15(3):340-9. doi: 10.1016/j.jcf.2016.01.004. Epub 2016 Feb 5.

Abstract

With intensified antibiotic therapy and longer survival, patients with cystic fibrosis (CF) are colonized with a more complex pattern ofbacteria and fungi. However, the clinical relevance of these emerging pathogens for lung function remains poorly defined. The aim ofthis study was to assess the association of bacterial and fungal colonization patterns with lung function in adolescent patients with CF. Microbial colonization patterns and lung function parameters were assessed in 770 adolescent European (German/Austrian) CF patients in a retrospective study (median follow-up time: 10years). Colonization with Pseudomonas aeruginosa and MRSA were most strongly associated with loss of lung function, while mainly colonization with Haemophilus influenzae was associated with preservedlung function. Aspergillus fumigatus was the only species that was associated with an increased risk for infection with P. aeruginosa.Microbial interaction analysis revealed three distinct microbial clusters within the longitudinal course of CF lung disease. …

[Read the Article]

Since the legalization of marijuana in Colorado, there has been an increase in hospital visits and calls to regional poison centers due to unintentional marijuana exposure among young children. Researchers from the University of Colorado evaluated the number of children with exposures before and after recreational marijuana was legalized.

Between 2009 and 2015 they found a rise in the annual number of unintentional pediatric exposures. On average, these children were about two years old. Most children ingested the drug in edible forms such as candies and baked goods. Almost half of the patients seen in the children's hospital in the 2 years after legalization had exposures from recreational marijuana, suggesting that legalization did affect the incidence of exposures.

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Host: Brian P. McDonough, MD, FAAFP

Over one million amputees suffer from phantom limb pain, a debilitating condition made all the more complex to treat due to the root question "How do I treat pain arising from a limb that no longer exists?" But new understandings of the pathophysiology behind this disease have led to more meaningful interventions, enabling better counseling strategies for primary care physicians.

Dr. Brian McDonough speaks with Dr. J. David Prologo, Assistant Professor of Radiology at Emory Healthcare and Director of Interventional Radiology Services at Emory Johns Creek Hospital. Dr. Prologo has helped pioneer research ushering in new treatment methods, such as cryoablation, for the treatment of phantom limb pain in amputees.

Host: Jennifer Caudle, DO

Dr. Mary Guinan was one of the first scientists to conduct an initial investigation into the emerging HIV/AIDS epidemic for the Center for Disease Control and Prevention. Additionally, she was one of the first female physicians to work on smallpox eradication and has been a leading researcher and educator on sexually transmitted diseases.

Dr. Mary Guinan is the founding dean of the School of Community Health Sciences at the University of Nevada, Las Vegas, and is now a professor emerita.

She joins Dr. Jennifer Caudle to discuss her book, Adventures of a Female Medical Detective which explores Dr. Guinan's life in medicine, including her many experiences with emerging disease outbreaks and the efforts to control them. She provides a unique female perspective from a time when very few women worked in the field.

Host: Matt Birnholz, MD

Dr. Matt Birnholz sits down with Michael Freytag, an attendee at the Villanova Health Summit, to talk about his reactions and thoughts on the keynote presentations and panel discussion. The two discuss outlooks on the future of multidisciplinary teams in health care, and how standard views on "change agents" within this field may evolve over time.