PVRoundup Podcast

This week's episode covers the effectiveness of a fixed-dose albuterol-budesonide combination for asthma, new findings on Nerodomelast for progressive pulmonary fibrosis, the FDA's endorsement of a new COVID-19 vaccine targeting the JN.1 lineage, and insights into extended-phase anticoagulation for pediatric venous thromboembolism.

A Lancet study warns of consequences for HIV prevention if PEPFAR loses funding, potentially millions of new pediatric HIV cases and increased AIDS-related deaths. Medicare Part D is highlighted, with research linking subsidy loss to higher mortality rates. A report from BMJ notes a 3.1% decline in U.S. drug overdose deaths, signaling a possible peak in the fentanyl crisis.

Drs. Pemmaraju and Bose discuss the revised International Working Group criteria for anemia response in patients with myelofibrosis, outlining new definitions for transfusion status, gender-specific hemoglobin thresholds, and benchmarks for major and minor responses.

Drs. Bose and Pemmaraju discuss leukemic transformation in patients with myelofibrosis, reviewing its incidence, as well as risk factors, treatment, and prognosis.

Drs. Bose and Pemmaraju review secondary myelofibrosis arising from polycythemia vera or essential thrombocythemia and how it differs from primary myelofibrosis that develops de novo.

Maternal RSV vaccines and infant nirsevimab led to major drops in hospitalizations among infants ≤7 months, especially those ≤2 months old. The CDC's 2025 nPEP guidelines stress starting HIV prevention within 72 hours of exposure, with rapid testing and follow-up care. Treatment should begin without delay, and patients at ongoing risk should transition to PrEP. Surgical site infections after colorectal surgery have increased 21% since 2019, highlighting the need to strengthen infection control.

Drs. Starling and VanderPluym discuss common diagnostic pitfalls in migraine medicine and how the misinterpretation of symptoms can lead to unnecessary testing or incorrect treatments.

Drs. VanderPluym and Starling review the updated position statement from the American Headache Society indicating that CGRP-targeting migraine therapies should be considered as a first-line option.

This episode features the Beamion LUNG-1 trial, where zongertinib showed a 71% response rate in previously treated HER2-mutant NSCLC patients. The EAGLE-1 trial found gepotidacin non-inferior to standard treatment for urogenital gonorrhoea, with a 92.6% success rate. The U.S. Department of Health and Human Services and NIH launched the Generation Gold Standard initiative, a universal vaccine platform targeting pandemic-prone viruses, with trials ongoing for H5N1 avian influenza and coronaviruses.

Elizabeth Kensinger, PhD and Andrew Budson, MD explain how healthy lifestyle habits, memory offloading strategies, and turning facts into stories can support cognitive aging. They stress that enriching and novel activities are more effective for brain health than most apps. Dr. Budson supports the theory that beta amyloid defends against brain infections, linking it to viral triggers of Alzheimer's. He also highlights new drugs like lecanemab and donanemab that may slow early Alzheimer's progression and potentially prevent its onset.

A JAMA model warns measles could become endemic in the U.S. within 21 years if MMR vaccination rates don't rise, with over 850,000 projected cases. A Phase 3 NEJM trial found brensocatib reduced exacerbations in non-CF bronchiectasis. An EPIC study correlated higher breast cancer risk to higher education levels, beyond lifestyle and reproductive factors.

Mexico's first fatal H5N1 case involved a healthy child and highlights localized risk despite low global concern. Long-term antidepressant use was linked to higher sudden cardiac death risk, especially in younger adults. A U.S. study found 25% of adults with very high LDL cholesterol lacked statin treatment. These stories reveal persistent gaps in infection control, cardiac monitoring, and preventive care.

A polygenic risk score significantly improved prostate cancer detection beyond PSA testing, identifying more treatable and aggressive cancers in high-risk men. New WHO guidelines aim to reduce global meningitis deaths by standardizing early diagnosis, treatment, and care across settings. GLP-1 receptor agonists and SGLT2 inhibitors were linked to reduced Alzheimer's risk, with GLP-1s showing the most consistent neuroprotective effects in recent studies. Lastly, breast cancer mortality was 47% higher among Black women living in disadvantaged neighborhoods, underscoring the impact of social determinants on survival.

Mary Beth Cicero, co-founder of Three Daughters, shares how her passion for women's health led to the development of a new frameless, self-assembling magnetic IUD designed to significantly reduce the pain of insertion and retrieval. The device, inspired by embryo transfer techniques and using copper as its active ingredient, aims to improve comfort, eliminate strings, and offer a more body-conforming contraceptive option—especially for younger women deterred by current IUDs. As the product moves through clinical trials, the team is focused on both efficacy and ease of use, with hopes to expand into treating other uterine conditions in the future.

A large study in Wales found that older adults who received the shingles vaccine had a 20% lower risk of developing dementia over seven years, with the strongest effect seen in women. U.S. measles cases have surged past 500, driven largely by outbreaks in West Texas and linked to international travel, underscoring critical gaps in vaccination coverage. Meanwhile, new research shows that even the wealthiest Americans have shorter life expectancies than their European peers, pointing to systemic health disadvantages in the U.S.

Drs. Yu and Sabari trace the evolution of HER2-mutant lung cancer treatment from chemotherapy to targeted therapies, highlighting key advancements, challenges, and patient responses. They also explore emerging treatment strategies, resistance mechanisms, and the future of personalized therapy based on biomarkers and co-mutations.

A study published in JAMA Internal Medicine found that statin use in patients with chronic liver disease was associated with a lower risk of liver cancer and hepatic decompensation, suggesting potential protective effects beyond lipid management. Surveys by the Annenberg Public Policy Center revealed widespread misinformation about the risks of consuming raw milk, highlighting the need for public education on the importance of pasteurization. New research links red meat allergy (alpha-gal syndrome) to bites from deer ticks and western black-legged ticks, expanding the geographic risk area and emphasizing the need for clinicians to consider this diagnosis in patients with unexplained allergic symptoms following tick bites.

Drs. Sabari and Yu discuss the molecular landscape of HER2-mutant lung cancer, including its genomic characteristics, common co-mutations, and differences between HER2 mutations and HER2 amplification. This discussion also explores the prevalence and clinical patterns of HER2 mutations, their oncogenic mechanisms, their impact on tumor behavior and metastases, and potential environmental or genetic contributors to their development.

Helena Yu, MD and Joshua Sabari, MD explore the importance of testing for HER2 alterations in lung cancer; how HER2 positivity influences clinical decision-making; and the key methods used for detection, including immunohistochemistry, fluorescence in situ hybridization, and next-generation sequencing. It also addresses challenges in standardizing HER2 testing, disparities in access to biomarker testing, and the evolving role of liquid biopsy compared to traditional tissue biopsy.

Carrie Dougherty, MD, FAHS and Jessica Ailani, MD review migraine abstracts from the 2024 European Headache Congress.

A phase 3 study showed that combining pelabresib with ruxolitinib significantly improved spleen volume reduction and symptom relief in myelofibrosis patients compared to ruxolitinib alone, offering a promising new treatment option. Long-term use of gantenerumab may delay Alzheimer's dementia onset in individuals with inherited Alzheimer's, supporting the amyloid hypothesis and paving the way for future prevention strategies. Phase 3 trials demonstrated that povorcitinib, an oral JAK1 inhibitor, significantly improved clinical outcomes in adults with moderate to severe hidradenitis suppurativa, potentially offering a new treatment option. Research linked red meat allergy to bites from additional tick species, expanding the geographic risk area and highlighting the need for clinicians to consider this diagnosis in patients with unexplained allergic symptoms following tick bites.

Jessica Ailani, MD and Carrie Dougherty, MD, FAHS debate initial preventive treatment for migraine and the in-clinic management of status migraine.

Drs. Lebin and Nagle-Yang discuss the pharmacological management of PPD, with a focus on the risks and benefits of selective serotonin reuptake inhibitors (SSRIs) and zuranolone.

Drs. Nagle-Yang and Lebin discuss the barriers to care engagement for patients with PPD, including such factors as stigma, fear of judgement, and access to treatment.

Sarah Nagle-Yang, MD and Lindsay Lebin, MD review the screening, impact, and management of suicide risk in patients with PPD, highlighting effective prevention strategies.

A study suggests GLP-1 receptor agonists may reduce hematologic cancer risk in type 2 diabetes patients by 54% compared to insulin. Two individuals have achieved functional HIV cures through stem cell transplants, offering insights into cure strategies. Additionally, women with dense breasts face double the risk of breast cancer and reduced mammogram accuracy, supporting FDA regulations for breast density notifications and additional screening methods.

An AI system trained on breast ultrasound studies showed promise in reducing false positives and biopsies by over 37% and 28%, respectively, while maintaining sensitivity, potentially aiding clinical decision-making. Second, nirsevimab demonstrated effectiveness in preventing RSV infections and hospitalizations among infants, with protection waning over time but remaining significant. Lastly, breast and colon cancer screening rates in the U.S. have surpassed pre-pandemic levels, but cervical cancer screening rates remain concerningly low, highlighting disparities in access to preventive care.

Drs. McClung and Singer delve into common questions and clinical conundrums encountered in managing osteoporosis and fractures, including calcium use and dental procedures, in patients with osteoporosis.

Drs. Singer and McClung discuss the operationalization of a bisphosphonate “drug holiday” in people treated with this class of osteoporosis medication. They address questions regarding patient selection criteria, duration of the holiday, and strategies for determining when and with what medication treatment should be resumed.

Andrea J. Singer, MD, FACP, CCD and Michael R. McClung, MD review the preservation of bone health in perimenopausal women, with a particular focus on the role of hormone therapy and how the interplay of hormonal, lifestyle, and genetic factors is key to developing effective prevention and treatment strategies.

A Texas child's measles-related death, the first in the U.S. since 2015, highlights rising cases amid declining vaccination rates. AstraZeneca's Serena 6 trial found camizestrant, delayed disease progression in HR-positive HER2-negative breast cancer. A BMJ study found no link between GLP-1 receptor agonists and increased suicidality in diabetes patients. The CDC reports an 80% decline in high-risk cervical precancers, confirming HPV vaccination success.

Dr. Andrew Budson discusses the relationship between consciousness and memory, proposing that consciousness evolved as part of the memory system. He explains how unconscious processes drive much of our decision-making, with consciousness acting as a memory-based guide to influence behavior. He highlights the role of attention in memory retention and how false memories, particularly in Alzheimer's patients, arise due to the brain's reconstructive nature. Dr. Budson also explores the implications of this understanding for treating PTSD, addiction, and cognitive disorders.

This podcast reports a severe flu season, with hospitalizations exceeding previous years and rising pediatric flu deaths. A Texas measles outbreak, mainly in unvaccinated children, has reached nearly 60 cases, with more in New Mexico, highlighting vaccine decline risks. Research finds moderate to vigorous leisure activity lowers type 2 diabetes risk, while strenuous work activity does not. A UCLA study questions Paxlovid's effectiveness in preventing COVID-19 hospitalizations in vaccinated older adults, raising cost-effectiveness concerns.

Drs. Traina and Isaacs share how they determine which patients are appropriate for neoadjuvant therapies and how to address residual disease, as well as potential treatment toxicities.

Drs. Tiffany A. Traina and Claudine Isaacs discuss how they approach HER2+ early breast cancer treatment planning and which patients can take advantage of de-escalation.

Measles cases are rising in Texas and New Mexico, with most infections occurring in unvaccinated individuals and public health officials warning of further spread. A new study in JAMA Psychiatry found that semaglutide significantly reduces alcohol craving and heavy drinking, suggesting a potential new treatment for alcohol use disorder. Research confirms that self-sampling for HPV is as effective as speculum-based exams, improving accessibility for women with disabilities and underserved populations. With the FDA's recent approval, self-collection could revolutionize cervical cancer screening in the U.S.

Professor Alexander Jensen discusses parental favoritism and its impact on family dynamics, highlighting that both mothers and fathers tend to favor daughters, potentially due to social and evolutionary factors. The study suggests that children who receive less favorable treatment may experience negative mental health and behavioral outcomes, including increased risk-taking and lower self-esteem. The discussion also touches on how favoritism can persist into adulthood, influencing sibling relationships, caregiving responsibilities, and even long-term physical health.

This podcast features Marlee Tunduk, the lead author of a study on learning and attention in young children finding that children aged 7 to 9 learn differently from adults; they absorb information more generally from their environment, regardless of specific tasks or goals. This "sponge-like" learning suggests that children benefit from immersive and engaging environments rather than structured, task-focused learning. The findings highlight the importance of understanding and accommodating children's natural attentional systems in educational and parenting contexts. The discussion also touches on the potential implications for teaching methods and future research directions, emphasizing the need to explore how these learning differences manifest in various settings.

Can a urine test reduce unnecessary prostate biopsies?

A new phase 3 trial demonstrated that adding nivolumab to adjuvant chemotherapy significantly improves outcomes for patients with ER-positive HER2-negative breast cancers. Heavy lifetime cannabis use was associated with reduced brain activity in areas responsible for working memory, suggesting potential long-term cognitive impacts. A study found that EMS clinicians wearing ballistic vests experienced higher rates of workplace violence and increased patient refusal of treatment, particularly among racial and ethnic minority patients.

Drs. Solomon and Swigris review how they discuss lung transplantation with patients with ILDs, as well their philosophies of addressing end-of-life issues and the use of opioids in managing symptoms in these patients.

Drs. Solomon and Swigris focus on the importance of managing comorbidities and addressing treatment-related adverse events, such as GERD and mood disorders, in patients with ILDs to improve quality of life. Pulmonary rehabilitation is also emphasized as a vital component of care for these patients.

A study in NEJM shows that abelacimab, a fully human monoclonal antibody targeting factor XI, significantly reduces bleeding risk compared to rivaroxaban in atrial fibrillation patients, suggesting a safer alternative for stroke prevention. Data from JAMA Health Forum reveals growing consolidation of primary care practices by hospitals and private equity firms, driving up healthcare costs without clear quality improvements. The largest U.S. tuberculosis outbreak in Kansas underscores the importance of vigilance and rapid response by healthcare providers, while a study in JAMA Network Open finds women, particularly nonmenopausal females aged 40–54, at higher risk for long COVID, emphasizing the need for tailored prevention and treatment strategies.

Drs. Solomon and Swigris discuss how the treatment of ILDs demands a personalized approach based on the underlying cause and progression of the condition. They explore therapeutic options, including antifibrotic agents and immunosuppressive therapies.

Joshua Solomon, MD and Jeff Swigris, DO discuss ILDs, a group of conditions marked by lung inflammation and fibrosis. They explore classifications, common causes, and advancements in understanding of these disorders to support effective diagnosis and management.

A study in Neurology links high intake of processed red meat to an increased risk of dementia and cognitive decline, with dietary changes showing protective effects. Research in the Journal of Arthroplasty highlights that COVID-19 infection within six weeks before knee surgery significantly raises the risk of venous thromboembolism. Wearable devices, such as Apple Watch and Fitbit, can predict inflammatory bowel disease (IBD) flares up to seven weeks in advance by monitoring physiological metrics, offering a valuable tool for early intervention.

This discussion emphasizes the importance of risk mitigation strategies and practical tips for implementing oral immunotherapy (OIT) in clinical practice. Key points include ensuring adult supervision during dosing, adhering to safe dosing rules to minimize allergic reactions, and maintaining close communication with healthcare providers for adjustments or emergencies. The conversation highlights the challenges of adherence, the need for proper patient and caregiver training, and the critical role of informed consent in supporting successful and safe long-term OIT management.

In this discussion, Dr. Anagnostou and Dr. Greenhot review key elements for informed consent in oral immunotherapy (OIT), emphasizing the benefits, risks, and outcomes of the treatment. They highlight OIT's ability to increase allergen tolerance thresholds, while acknowledging potential risks like dose-related reactions and rare conditions such as eosinophilic gastrointestinal disorders. Alternatives to OIT, including food avoidance, emerging biologics, and clinical trial participation, are also discussed, with a focus on empowering clinicians to guide families in making informed decisions.

Aikaterini Anagnostou, MD (Hons), MSc, PhD and Matthew Greenhawt, MD, MBA, MSc discuss the process of preparing patients for oral immunotherapy (OIT). This first part of a 3-part video highlights the development and findings of the first International Delphi Consensus Panel on preparing patients for oral immunotherapy (OIT). Experts created a standardized checklist and consent framework to guide clinicians in counseling families about OIT, emphasizing its long-term, stepwise desensitization process and associated risks. Key considerations include controlling patient comorbidities like asthma, ensuring family commitment and agreement, and tailoring counseling to logistical and cultural factors to optimize adherence and success.

Tejas Patil, MD and Sami Diab, MD discuss the pivotal role HER2 positivity plays in lung cancer including the challenges faced by clinicians in testing for HER2. They discuss topics in sequencing, next generation testing, and liquid biopsies as well as challenges of testing in tissue-efficient manner.

Drs. Isaacs and Traina share insights from the 2024 San Antonio Breast Symposium, covering the MARGOT trial, survival impacts of risk-reducing surgeries in young BRCA carriers, and outcomes of delaying surgery in operable breast cancer.