Health Newsfeed – Johns Hopkins Medicine Podcasts

Antibodies in the blood of people who’ve had COVID and recovered can help others avoid severe cases of the disease, use of this treatment in some has shown. Yet when larger scale clinical trials were undertaken, results were largely lackluster, and the treatment has fallen by the wayside. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, reflects on why results were mixed.

Casadevall: Last year there was a lot of excitement for convalescent plasma, half a million people got treated. Then came some really poorly designed clinical trials. People were treated very late. Well, if you do a trial and it didn’t work because you set it up not to work then plasma doesn’t work. And then what happened is there was a reduction in use. We were able to document that as the use went down more people died.  :26

Casadevall says convalescent plasma is a viable treatment for COVID infection, and he’s trying to make both physicians and patients aware of the need to use it early in the infection to maximize its benefits. At Johns Hopkins, I’m Elizabeth Tracey.

Convalescent plasma is plasma donated by people who’ve already had COVID and recovered. Early in the pandemic this historically successful technique was attempted to stem the tide of COVID-related death, but now the therapy has fallen into disuse. Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, explains.

Casadevall: We are talking about a therapy that is given once that costs $300.00. What is the risk benefit of this? And people are not using it. This therapy works best when given early. COVID has two phases, a viral phase and an inflammatory phase. The inflammatory phase is what puts you in the hospital. That’s because it interferes with gas exchange, people get short of breath. The antibody works on the viral phase, so many people when they show up in the emergency room are already too late to be helped. But not all of them are that late.   :30

Casadevall is trying to raise awareness of convalescent plasma therapy, which he says could benefit many and reduce the need for hospitalizations nationally. At Johns Hopkins, I’m Elizabeth Tracey.

Remote monitoring helps people undergoing treatment for cancer cope better with emerging symptoms, a new study concludes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this strategy may be even more important as new cancer treatments are developed.

Nelson: One of the things about chemotherapy is we sort of have a good sense when people get into trouble with nausea and vomiting, when people get into trouble with an increased risk for infection. When we look at some of the new immunotherapy agents people can get in trouble with activating the immune system attacking some normal part of the body. They’re a little bit less predictable but it’s very clear if the early symptoms are captured and it prompts an intervention that you can stop this autoimmune attack and not compromise the benefit of the immunotherapies.  :30

Nelson says data from remote monitoring can be integrated into electronic medical records so it is instantly available for care teams to respond. At Johns Hopkins, I’m Elizabeth Tracey.

People who used a remote monitoring tool to report daily symptoms as they underwent cancer treatment did better with regard to managing their treatment than those who did not, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, isn’t surprised.

Nelson: What they were looking at were symptoms that people started with and symptoms that they would acquire as they are being treated with chemotherapy and radiation therapy and the like, is monitoring this basically at home 24 hour monitoring with one of these tools, can they identify symptoms and intercept them in some way so that they could be better managed. The answer was yes. When they did this kind of monitoring, when you looked at the folks who did the monitoring they didn’t get that much more and the more would have been related to the treatment and so managing the treatment associated symptoms with this monitoring tool seemed to be helpful.  :32

Nelson says people also like participating in their own care and felt more in partnership with their medical team. At Johns Hopkins, I’m Elizabeth Tracey.

People who are 75 and older and otherwise healthy reap benefits from continuing colorectal cancer screening, a new study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says that with new fecal screening tests, such a strategy makes even more sense.

Nelson: I think for the time being I think what is going to happen pretty quickly is that in this particular dataset they were not able to look back and make significant comments on the DNA containing stool tests. The Cologuard, that’s FDA approved, there’s other ones coming I think. And how often should you have that? Would that be a reasonable strategy to even more fine tune who gets colonoscopy who doesn’t when you get older. I think there’s going to be a lot more to be said about this and it’s going to be in the favor of there are people above the age of 75 who need to be screened.  :31

Nelson notes that this issue of age and cancer screening in general is actively being investigated by many, as is how best to treat older adults with cancer. At Johns Hopkins, I’m Elizabeth Tracey.

Colorectal cancer screening is recommended to begin at age 45, but at what age should it end? A new study finds that even in many over the age of 75, screening can still be beneficial. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: This study looks at what should we do with people when they get over the age of 75. They used data from the Nurses Health Study and the Health Professional Follow up Study and there was a clear advantage to screening after the age of 75. Whether you’d been screened before age 75 or not. The real reason you might think about not doing so much screening is related to the jargon term is competing causes of mortality, in other words if you have somebody who’s in an intensive care unit because their heart doesn’t work very well screening them for colorectal cancer not likely to be helpful.  :33

Nelson says that continuing screening or not should be a topic for discussion with your primary care physician. At Johns Hopkins, I’m Elizabeth Tracey.

Rates of diabetes are increasing, recent data indicate, and factors related to the pandemic seem likely to be related. Rita Kalyani, a diabetes expert at Johns Hopkins, describes some of them.

Kalyani: As we see less face to face interaction during the pandemic, less attention to healthy lifestyle behaviors, for good reason in many cases, fear of being outside, fear of going to the gym, all the things that we hear about. But we are going to see maybe a spike in the prevalence of these risk factors because during the pandemic people just weren’t able to follow the same routines as they were pre-pandemic. In some ways we might expect it’s going to take us back a little bit.  :29

The pandemic has also compromised how well clinicians can manage different aspects of diabetes care, which some are calling ‘treatment stagnation.’ For now, Kalyani says those with diabetes must redouble their efforts to keep the condition under control and become as educated as possible about the disease. At Johns Hopkins, I’m Elizabeth Tracey.

The number of people who have diabetes continues to increase but controlling it, along with other common health conditions that can make things worse, has stagnated, a recent study concludes. Rita Kalyani, a diabetes expert at Johns Hopkins, describes the data.

Kalyani: Diabetes prevalence increased from about 9.8% to about 14%. Discouragingly risk factor control really did not improve. Individualized A1c targets, they found out there really wasn’t much change at all. How many had achieved a blood pressure less than 130 over 80 they also found it had definitely not improved. When they looked at the percentage that had attained LDL less than 100 they also did not find find significant improvement. Only one in five achieved all three targets.  :32

Kalyani says keeping blood pressure, blood sugar and cholesterol in check is your best bet to avoid cardiovascular disease if you have diabetes, and even if you don’t. At Johns Hopkins, I’m Elizabeth Tracey.

The majority of people with diabetes who were only in their twenties had a least one complication of the condition already, a recent study shows. Rita Kalyani, a diabetes expert at Johns Hopkins, says this study points very squarely to obesity as the underlying cause.

Kalyani: If we take a step back and ask ourselves why are so many youth now being diagnosed with type 2 diabetes, racial and ethnic minorities are more likely to develop it, but really it’s becoming an epidemic in youth as well. And when we look at BMI as a measure of obesity, the average BMI in this cohort was 35. These children were quite obese. This is not necessarily generalizable to the population of children in the United States but it shows how important weight management is from a young age.  :33

Kalyani notes that long term complications of diabetes are also linked to increased rates of cardiovascular disease and earlier death. She urges policymakers to focus on mitigating the childhood obesity epidemic we’re witnessing worldwide. At Johns Hopkins, I’m Elizabeth Tracey.

Even if you’re only in your twenties if you’ve had diabetes for 10 years or more kidney disease, eye disease and nerve disease are likely, a sobering new study finds. Rita Kalyani, a diabetes expert at Johns Hopkins, says this study also finds the underlying common denominator, a measure of blood sugar known as hemoglobin A1c.

Kalyani: Now the question becomes how do we prevent these complications from developing? And when you look at their glycemic control, which is important, they weren’t able to maintain their glycemic control during this time. In fact only about 20% of them at the end of 15 years, had an A1c less than 6.5%, and one-third of them had an A1c greater than 10%. And so I think what this study really reveals is the importance of focusing on glycemic management from a young age.  :31

Kalyani urges young people with diabetes to focus first on controlling their blood sugar. At Johns Hopkins, I’m Elizabeth Tracey.