Health Newsfeed – Johns Hopkins Medicine Podcasts

Anchor lead: Can smell changes be explained by Sars-CoV2 infecting that area of the nose? Elizabeth Tracey reports

We all have proteins on the surface of cells in our bodies known as receptors, and one of them, abbreviated ACE2, is used by Sars-CoV2 to infect us. Now research by Andrew Lane, an otolaryngologist at Johns Hopkins, and colleagues, has shown that the area in our nose involved in the sense of smell has several hundred times more ACE2 than other areas of the nose.

Lane: Well if that’s really true could you direct a therapy towards the olfactory epithelium and try to nip it in the bud? The other angle is if it really is there in a lot of people who are otherwise asymptomatic would it be possible as a screening tool to study the olfactory system. Maybe some simple test might catch some proportion of people who have olfactory dysfunction but not olfactory loss, it may be a more subtle change in their sense of smell that might indicate they’re infected.  :25

Lane notes that some researchers have developed a scratch and sniff card to help screen people who may have very minor changes in their sense of smell, and that might point toward those capable of spreading the virus even though they have no other symptoms. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Tissue in your nose may be the first site Sars-CoV2 binds to, Elizabeth Tracey reports

ACE2 is the acronym for the site on cells Sars-CoV2 uses to bind and then infect them. Now research by Andrew Lane, an otolaryngologist at Johns Hopkins, and colleagues, has shown that the very specific area of the nose where cells responsible for the sensation of smell reside – called the olfactory epithelium -  may also be where the coronavirus goes first.

Lane: We did staining to find the location of this ACE2 protein. We were surprised to see it was hundreds-fold, somewhere between 200 and 700 times more expressed on the part of the cell facing outwards into the environment. That’s where all this ACE2 is, so it gives you a possible explanation for why the olfactory system might be a particular target of this virus. When we test for this virus we always test people’s nose because the other places you could sample like saliva or other bodily fluids don’t contain very much virus. The money’s always in the nasopharyngeal swab.   :31

Lane says the next step is to take living tissue to see if the virus prefers this area. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How do attitudes toward condoms impact on their use among teens? Elizabeth Tracey reports

Sexually active teens don’t just need to prevent pregnancy, they also must avoid a host of increasingly common sexually transmitted infections, and that means using condoms. Yet a CDC study demonstrates that fewer than one in ten do so. Maria Trent, director of adolescent medicine at Johns Hopkins, comments.

Trent: We still have a condom problem. It’s kind of like mask wearing. It’s like a protective barrier. When do you wear it and when do you not? And what we’ve seen is that oftentimes people struggle with doing what is good for them from a public health perspective. We have to continue to encourage adolescents, provide positive messages around condom use, even when people may have long acting contraception, even when people may be on pre-exposure prophylaxis for HIV we have to continue to use condoms to prevent the everyday STDs that can truly disrupt their lives.   :31

Trent notes that some sexually transmitted infections are incurable or may have dire health consequences if they go untreated. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How has the pandemic complicated rates of sexually transmitted infections among teens? Elizabeth Tracey reports

While one-quarter of a nationally representative sample of teenagers said they were sexually active, fewer than one in ten said they used condoms while having sex, a CDC study finds. Maria Trent, director of adolescent medicine at Johns Hopkins, says the pandemic has complicated this issue for parents.

Trent: We still have to do the hard work of preparing them to make good decisions when they’re not with us, and that means we have to talk about sex, talk about condoms. For some people condoms may seem like a luxury. And so I think we have to really think about preparing young people to have what they need, but also to think about parents who may be struggling now, how are they going to give them those resources? I think it may be hard for families to purchase the supplies now.   :25

Trent notes that just like pediatrics practices, those that focus on adolescents also recognize and integrate the central role families play in their health. She urges parents to identify their needs and ask for help from their children’s providers, as they are often an excellent source for referral. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A very low percentage of sexually active teens use protection, Elizabeth Tracey reports

Fewer than one in ten sexually active teenagers use recommended protection, a Centers for Disease Control and Prevention study finds. Maria Trent, head of adolescent medicine at Johns Hopkins, says the current pandemic has made the situation worse.

Trent: We’re also not screening people during this time of Covid, which further exacerbates the problem that we might see in young people who are particularly at risk, those who are fifteen to twenty-five are at most risk. We need to start thinking about how we are going to address other infectious diseases, even during the Covid pandemic, even when its over, I think we’re going to have to have a plan for how we’re going to take care of patients, to screen people for STDs, to get them treated, to get their partners treated, we really are going to have to work on that.   :29

Trent says barriers to teens coming into clinics for testing and treatment are higher now than ever, and worries that for some young women, the complications of untreated STIs may include infertility down the road. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Do we need to be concerned about more Sars-CoV2 transmission this fall in the Northern hemisphere? Elizabeth Tracey reports

As the pandemic began in the much of the world this spring, cooler temperatures have emerged as one factor leading to higher rates of transmission of Sars-CoV2, according to research by Adam Kaplin, a researcher and psychiatrist at Johns Hopkins, and colleagues. Kaplin says temperature alone isn’t the whole picture.

Kaplin: It’s not all one thing or another but what I think it’s saying is that if you currently are in a place where your social intervention has you at this stable place, as it gets cooler it’s not going to be enough. It’s going to start to take off. So we know that when we stop the social interventions it has begun to go up again, but the rate at which it is going up I think it going to increase as it gets cooler. :30

Kaplin says renewed emphasis on avoiding crowds and use of masks is at minimum a prudent strategy to avoid infection. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: How important is outdoor temperature in the spread of Sars-CoV2? Elizabeth Tracey reports

Factors associated with increased rates of transmission of Sars-CoV2 include increased population density, younger age of the population, and cooler outdoor temperatures. That’s according to a study by Adam Kaplin, a researcher and psychiatrist at Johns Hopkins and colleagues.

Kaplin: As the temperature went up the rate of transmission went down, I can also say that even though it was going up where it was cooler the rate of transmission was much faster, even though yes, it was going in the up direction the cooler it was the faster the transmission and we know from all the respiratory viruses that have temperature sensitivity, when the rate goes down when it gets warmer it goes up when it gets cold.   :28

Kaplin’s concern is that as the Northern hemisphere moves into fall and winter, the temperature variable may become more important in the transmission of Sars-CoV2  At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What do fall temperatures portend for Covid-19? Elizabeth Tracey reports

Cooler temperatures during the spring of 2020 were associated with faster transmission of Sars-CoV2, a study by Adam Kaplin, a researcher and psychiatrist at Johns Hopkins, and colleagues has shown. Kaplin describes the findings.

Kaplin: What we showed was that as the temperature was increasing going from January to April in these fifty countries in the Northern hemisphere our data says the higher the temperature the slower the increase in transmission,  early on when its still kind of linear, and before you have social interventions. But once you begin to take off, you get the social variables involved and then it’s no longer looking at just the temperature.  :32

Kaplin says interventions such as physical distancing, closure of schools and indoor gathering spaces, and wearing of masks then overcame the impact of temperature in transmission. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: An orthodontist may be the first specialist for an infant with cleft lip/palate, Elizabeth Tracey reports

Infants born with cleft lip and/or palate can benefit greatly by early intervention from an orthodontist, the team at Johns Hopkins has found. Ilana Ickow, a Hopkins orthodontist who specializes in treatment of babies with the conditions, describes first steps.

Ickow: When a baby is born with cleft lip and palate a process called nasoalveolar molding or NAM for short is done and an appliance that looks like a retainer is used to make the gum segments in the mouth closer together. It also moves the lip segments closer together. This process is started within the first few days of life and can last three to six months depending on the severity of the cleft. The goal is to give the mouth and the nose a more normal anatomy, to give the surgeon a better starting point for surgery.   :30

Ickow says babies are also fed with a special bottle during this time. She notes that using the appliance also helps both mouth and nose achieve a more symmetrical position. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Diagnosing cleft lip and palate using ultrasound has advantages, Elizabeth Tracey reports

Cleft lip and/or palate is very common, occurring in about one in 700 to one in a thousand babies born with condition in the US each year. Jordan Steinberg, a plastic surgeon at Johns Hopkins who specializes in treating these children, says early identification helps.

Steinberg: Today we have very good success even at the screening 20 week ultrasound for pregnant moms, if a cleft lip and/or palate is identified we try to set them with a visit right around that time period with our team to help get some information about what may be ahead. Many families really benefit from that experience because of the preparedness that they can gain prior to the birth of their child. Some of the things that we concentrate on are feeding, we will meet with the orthodontist, then we transition into a discussion about what are the major surgical milestones during that first year of life.  :35

Steinberg says the team at Hopkins takes a comprehensive approach to treatment since the condition impacts many aspects of life, such as feeding and speech. I’m Elizabeth Tracey.