Podcasts about azathioprine

Azathioprine is a common medication for people with chronic illnesses. Over 800,000 people are prescibed it in the US alone. Today I dig into details, what you need to know, and share my own experience as well as several other people's experiences. Please don't forget to click that subscibe button whereever you listen to the podcast and do me a HUGE favor and leave a review! These two things help others find the podcast, find our community, and feel a little less alone in their journey through life with chronic illness!   Join us on Instagram: https://www.instagram.com/teamvasculitis Join the Email List: https://teamvasculitis.com/team-vasculitis-email

When the "best" treatment that works for the "vast majority" of people with your disease... doesn't work for you. What's next? In today's episode I talk about the treatment that did work, some really tough discussions my husband and I had to have, and the devestation when you start to have a flare even though you're doing EVERYTHING right. Links mentioned in the episode: https://pubmed.ncbi.nlm.nih.gov/19129430/ https://www.drugs.com/sfx/azathioprine-side-effects.html https://us.fertility.com/fertility-facts/fertility-preservation/egg-embryo-freezing   Please don't forget to click that subscibe button whereever you listen to the podcast and do me a HUGE favor and leave a review! These two things help others find the podcast, find our community, and feel a little less alone in their journey through life with chronic illness!   Join us on Instagram: https://www.instagram.com/teamvasculitis Join the Email List: https://teamvasculitis.com/team-vasculitis-email

At 13 years old, Mia's life was turned upside down when she was diagnosed with Crohn's Disease. After enteral nutrition did not work, the doctors tried her on Azathioprine. One day her doctor called in a panic as Mia's liver had reached toxic levels due to the medications. Since then, Mia and her family have been on a journey to find a way to have Mia heal and be free of medications. Finding High Carb Health was the turning point and Mia finally learned how the body can heal itself. After going through the program, being dedicated and putting in the work, Mia is now symptom and medication free. She now has a Life After Crohn's!! Free Consultation with High Carb Health: www.highcarbhealth.com/healthsurvey Mia's Testimony: "I was diagnosed with severe Crohn's disease and Shukul has guided me to health and back to the happy girl I used to be. I will forever be grateful for High Carb Health, I have learnt so much about my body and how I should live and I never want to go back to the old diet I was on. Thank you sincerely, guys".

Today's episode is about how Sam healed Crohn's Disease. Free consultation with High Carb Health: https://www.highcarbhealth.com/healthsurvey/ Self Healing Crohn's Disease with a Plant-based diet: I was diagnosed with Crohn's disease in 2007. I wanted to try to control this naturally, so I was careful about what I was eating. But over time it got worse. So I ended up on various medications, for example, Budesonide, Azathioprine, Pentasa, Infliximab and Mercaptopurine. Then in 2012, I had to have surgery to remove a section of the small intestine, large intestine and appendix. After the surgery, I felt so much better and life seemed to go back to normal. But then in 2014, the disease became active again, so I was put back on Mercaptopurine. I didn't really want to be taking this medication because of the side effects, but there seemed no other option. As it turns out I felt well on this medication and so continued taking it. The Doctors had told me this medication was for life. Then in 2020 one of my friends introduced me to High Carb Health. I looked on the website, read all about Shamiz and read loads of the testimonials. I thought a lot about it before I actually booked the free consultation. The consultation was very thought-provoking and Shamiz was so kind and caring that I thought there really must be something to this program. So many people have been helped, why not me? The consultation made me want to go plant-based, so overnight, I did. This helped when later I decided to do the 3-month program, the detox wasn't as bad because my body had already started to heal. I had some hair loss, aches and pains, skin rashes but my stools were “normal”. This was a very exciting part of the journey. I could feel myself getting better as each week went by. The support and guidance from Shukul each week was so valuable, there is no way I could have done this on my own. Now I feel I have the knowledge to keep healing and to stay symptom-free. My life now only 5 months since I started the program, is so very different, I am no longer taking medication, the one I was told was for life. I am symptom-free and mentally free from always wondering where the nearest toilet is. I have become much more positive as a result of the 5 key steps, food, water, sleep, exercise and mindfulness, and I am able to enjoy life so much more. Thank you to HCH for helping me heal. To anyone thinking about doing the program and taking control of your health and getting your life back, please do it, you will not regret it.

On this episode, I discuss azathioprine pharmacology, adverse effects, monitoring parameters, and drug interactions. Azathioprine is classified as an immunosuppressive agent so it is naturally going to be used for autoimmune type disorders and transplantation. Azathioprine has a boxed warning for myelosuppression. I talk more about this in the episode. Genetic testing is recommended by the AGA prior to the use of azathioprine. I discuss which tests might be helpful to reduce the risk of toxicity.

Imaging in neurocutaneous disorders - Piezogenic pitting of the fingers - Betamethasone mini-pulses vs azathioprine in vitiligo - Treatments for chronic spontaneous urticaria - Congenital malalignment of the great toenails http://dermaspherepodcast.com Check out our other podcast, Skincast! Luke and Michelle report no conflicts of interest.

The Filtrate:Joel TopfSwapnil HiremathNayan AroraJennie LinJoshua WaitzmanSpecial GuestsAlfred Kim assistant Professor at Washington University, director of the lupus clinic. Receives support from Arena Pharmaceuticals, manufacturer of volcloosporin, or at least he did before this episode aired.Dawn Castor assistant professor at The University of Louisville School of Medicine. She is on the speaker bureau for Arena Pharmaceuticals, manufacturer of volcloosporin. She was a site principle investigator (PI) as well as an author of the trial.EditorNayan AroraShow Notes:NIH Cyclophosphamide trial, long term follow-up: Combination therapy with pulse cyclophosphamide plus pulse methylprednisolone improves long-term renal outcome without adding toxicity in patients with lupus nephritis. Other important publications on this trial include:Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs NEJM 1986Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis Lancet 1992Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamideVoclosporin is approved by FDA in January 2021Previous Lupus Nephritis podcast with Dawn and Alfred: Freely Filtered 029: Belimumab for lupus nephritisRituximab în Lupus. The LUNAR Trial (Spoiler, it didn't work): Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab studySystematic review of the literature on reproducibility of the interpretation of renal biopsy in lupus nephritisConclusion The interpretation of renal biopsy in lupus nephritis is poorly reproducible, causing serious doubts about its validity and its clinical application. As it can lead to serious diagnosis, treatment and prognosis errors, it is necessary to intensify research in this field.The ALMS trials of mycohenolate mofetil (MMF) trials in lupus nephritisInduction: Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis (JASN 2009)Maintenance: Mycophenolate versus Azathioprine as Maintenance Therapy for Lupus Nephritis (NEJM 2011)Jacob deGrom on the mound. Baseball Reference. DeGrom is a two time Cy Young award winner, a 4-time All-Star and former Rookie of the Year winner.AURORA2: Aurinia Renal Assessments 2: Aurinia Renal Response in Lupus With Voclosporin (ClinicalTrials.gov)Aurinia Pharmaceuticals.KDIGO 2021 Glomerulonephritis Guidelines Daily aspirin vs placebo for suspected acute myocardial infarction is highly protective except for patients born under Libra or Gemini. Current misconception 3: that subgroup-specific trial mortality results often provide a good basis for individualising patient careMultitarget therapy for induction treatment of lupus nephritis: a randomized trial.Patient Benefits Justify Price of New Lupus Nephritis Drugs“The estimated annual price of belimumab is approximately $43,000 per patient; the estimated annual price for voclosporin is approximately $92,000 per patient.”2019 update of the EULAR recommendations for the management of systemic lupus erythematosus GuidelineDr. Glaucomflecken on TwitterCardiology vs Nephrology Round 1Nephrology vs Cardiology Round 2In the Heights (Wikipedia)The Mitchells vs. the Machines (Wikipedia)Paws in PrisonFlozinator pin

This episode covers azathioprine!

Azathioprine is an immunosuppressant drug. Here we review the mechanisms by which it could slow ALS progression, discuss the ALS reversals and the negative ALS trials associated with this drug, and highlight some of the serious side effects that can occur in patients taking it.

The following episode is a didactic activity. Our goal is teaching family medicine residents about these diseases and prepare them to treat their patients. We hope those who are suffering from these diseases do not find this activity offensive. May you find an appropriate treatment and get better. Consult your own family medicine doctor to learn more. Similar but different, sound-alike but opposite, analogous but heterologous. Welcome to the Sick Duel, an epic comparison between two merciless opponents. Our rivals today are: Ulcerative Colitis, “I will show you how to ulcer”; and Crohn’s Disease, “I will drill your guts”. Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the GI tract. Ulcerative colitis and Crohn's disease are the main representatives of these disease. Today we will hear why they don’t get along and hopefully we’ll come to a good end. Here we have our first guest Arreaza: Who are you?UC: Ulcerative Colitis is the name, and inflammation is the game. They say to save the best for last, so I tend to stick to the rectum and distal colon.  I like to come and go (no pun intended), creating episodic, mucinous diarrhea for my victims that is usually bloody.  I can be mild or severe, depending on the extent of mucosal involvement and level of inflammation.  Arreaza: How do you manifest?UC: I like to make my victims as uncomfortable as possible, creating urgency, pain, and constipation, while leaving them with a feeling like they aren’t “done” yet (aka tenesmus).  Arreaza: I thought you said diarrhea, and now you mention constipation?UC: Yes, I may cause periods of constipation when I am merciful, but diarrhea when I am cruel. Regardless of the thickness of the stools, I give them a mucinous and usually bloody discharge, sometimes leading to anemia. I like to attack extra intestinal organs such as the skin (causing pyoderma gangrenosum and erythema nodosum), the eyes (causing uveitis), and the joints (causing arthritis). Yes, my aunt Cronh’s can do some things right!6. Arreaza: I’ve heard Ms Cronh’s is really mean. Where else do you go?UC: Occasionally, I’ll make my way to the liver and cause primary sclerosing cholangitis.  My primary goal though is creating crypt abscesses and ulcerations.  If I’m lucky enough, I can progress to a fulminant, toxic level creating systemic symptoms and abdominal distention.  I hope to eventually make my way out of the GI tract through perforation (who doesn’t like a pinata?). Arreaza: I can see why your last name, colitis, can be deceiving, you can actually get out of the colon… Who are more likely to be your victims?UC: I like to run in families. I prefer people who eat lots of fatty foods (Standard American Diet anyone?), high omega-6:omega-3 ratio, with history of previous bouts of gastroenteritis.  HLA autoimmune association, especially HLA-DR2. Even though smoking is a risk in many diseases, in my case, cigarette smoking may protect my victims from my attack, but if they smoked before and quit, I have a better chance to show up.Arreaza: How do you get caught?UC:  My victims tend to have chronic diarrhea for at least four weeks.  Because I am an inflammatory villain, many inflammatory tests can be non-specific such as ESR, fecal calprotectin/lactoferrin, etc.  Therefore, if you want me, you’re gonna have to come and get me.  Beware of your hospitalized patients, as a colonoscopy will greatly increase my ability to form a toxic megacolon and perforation!  Flexible sigmoidoscopy is recommended and will show you crypt abscesses, friable mucosa, decreased vascular markings and my continuous pattern of inflammation, yes, continuous, you gotta be consistent, unlike Ms. Crohn’s who likes skipping like a loser! How do you get eliminated? (What humans call treatment)UC:  When my victims aren’t suffering as much as I’d like, those doctors first like to throw anti-inflammatories at me (such as mesalamine).  If that doesn’t work, they’ll throw in some steroids. However, if I’ve really done my job, then treatment usually starts with some immunomodulators (Azathioprine, Infliximab, etc.) followed by steroids with the goal of inducing remission.  If all else fails, they’re just gonna have to remove me along with my victims’ colon, so surgeons are their last resource to get rid of me!Arreaza: What determines how bad you will be? (Prognosis)UC:  Several factors influence my prognosis such as age of onset. Victims older than 50 have more chances to have a steroid-free remission. I hate smoking! Smoke does not let me grow, so when a patient quit smoking I can be more aggressive. When the intestinal mucosa heals early in the disease, my victims have a better prognosis. My chance of extension is higher in more distal areas, for example, patients with proctitis have 50% chance of extension. If my victims had an appendectomy before age 20, they have less chances of hospitalization and colectomy. With treatment, my victims may experience long periods of symptomatic remission along with intermittent exacerbations, although a small percentage may continue to have chronic symptoms and are less likely to achieve remission. The latter may require lifelong therapy or possible colectomy (Physicians 1, Me 0).  Ulcerative colitis, you really know how to ulcer. Now we invite our next guest.Arreaza: Who are you?Crohn’s: Hi everyone, I’m Crohn's disease and unlike UC I don’t only affect the colon but I can affect any area of the GI tract from the mouth to the anus. Not only can I affect the whole GI tract but also, I can affect all the layers of the GI wall. Doctors like to call that “transmural inflammation”. Also, I can be sneaky, showing symptoms for a long time before diagnosis or I can happen all of a sudden and be diagnosed acutely.How do you manifest?Crohn’s: There are a few ways I can show up, but mainly I cause crampy abdominal pain, diarrhea either bloody or non-bloody, fatigue and weight loss. If I’m only located in the distal ileum, then I will give you right lower quadrant pain. Since I have transmural inflammatory forces, I can cause formation of sinus tracts that can result in abscesses or phlegmons. Phlegmon is a word that a lot of radiologist like to use and it pretty much means the formation of an abscess but not yet an abscess, so it can’t be drained but can treated with antibiotics. Sinus tracts can end up in microperforations or even fistulas. A fistula is when a connection forms between two tissues that are not supposed to be connected and, yes, it kinda sucks for my victims, especially when this connection happens between the bladder and the colon and you end up with urine mixed with feces coming out of either end. Ohh and if it connects from the GI tract to the skin then you may have continuous leakage of feces. WOW! I’m terrible, I know…Arreaza: You are really mean!On a lighter note, sometimes I cause no symptoms… at least not for a while until I make your GI tract so narrow that you defecate less frequently and end up having pain, and eventually your tract becomes obstructed. Man, yeah this pretty much sucks too. My bad!Arreaza: I know you have more, tell us more about you.I almost want to stop telling you anything else but there are a few more things. For example, I could give you aphthous ulcers in the mouth, pain in the esophagus or difficulty swallowing, abdominal pain, watery diarrhea, steatorrhea or oily diarrhea. OMG there's a bit more; last but not least some people may also have: arthritis of large joints, skin disorders like erythema nodosum or pyoderma gangrenosum and very few will experience hepatobiliary involvement such as primary sclerosing cholangitis or even eye issues like uveitis, iritis and episcleritis… among others.Arreaza: You and your nephew UC really like going out of the GI tract, but I think you are more adventurous. Who are more likely to be your victims?Crohn’s: Unlike UC, I actually like smokers, smoke helps me thrive! Those who have antibiotic exposure are at risk, also those with increased fats in diet, and maybe a little increased risk with NSAIDs and OCPs. Appendectomy may be a result of hidden CD vs a risk factor. If you want to avoid CD, high fiber and a Vit D supplementation are associated with decrease risk of CD. If you were breastfed, you have lower risk to get CD.How are you caught? (diagnosis)Crohn’s: You can usually suspect CD when there is a combination of suggestive features, such as RLQ pain, chronic intermittent diarrhea, fatigue and weight loss. Laboratory tests can show anemia, vitamin B12 and Vitamin D deficiency (malabsorption). Diagnosis is made certain via imaging, endoscopy and histological findings that show the aforementioned “transmural inflammation”. I think everyone will remember this “transmural inflammation” sign.How can your victims fight you? (treatment)Crohn’s: The treatment will be different depending on where I’am at, how bad I am and whether you want to stop me or keep me quiet. If I’m mild, then you can use oral 5-aminosalicylates like sulfasalazine or mesalamine, glucocorticoids, immunomodulators such as methotrexate or azathioprine; and biologic therapies such as infliximab, adalilumab, etc. Yep, these are some pretty tough names to combat a tough disease like me!If I am moderate to severe then you’ll need a combo of meds: anti-TNF like infliximab plus an immunomodulator. The GI doctors are my archenemies! What determines how bad you will be? (prognosis)Crohn’s: It can vary, most of the patients will experience a continuous progression while about 20% of patients can experience remission after initial presentation. Risk factors for progressive disease are smoking, age

Ulcerative colitis affects nearly 700,000 Americans and causes symptoms ranging from diarrhea to arthritis to skin rash. Thankfully, medication options and surgery can significantly reduce symptoms and even bring about long-term remission for patients.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re speaking with Dr. Nidhi Malhotra, a gastroenterologist and Assistant Professor of Medicine at MedStar Washington Hospital Center. Today we’re discussing ulcerative colitis, which is an inflammatory bowel disease that causes long-lasting inflammation and ulcers, or sores, in the digestive tract. Welcome, Dr. Malhotra. Dr. Nidhi Malhotra: Thank you for having me. Host: Could you tell us what causes ulcerative colitis? Dr. Malhotra: So, ulcerative colitis is thought to be an auto-inflammatory condition in a genetically susceptible individual. Let me simplify that. So, someone with a genetic predisposition, meaning that they have genes that make them more susceptible to acquire this disease, and then there is an inciting event that triggers the inflammation. The inciting event could be an infection. It could additives or preservatives in our diet which have directly implicated in IBD. It could be chemicals. Or, it could be antibiotics. Or really, sometimes, a completely unrecognized reason as a triggering factor. But once triggered, the inflammation causes damage to the colon, and patients will start having symptoms. Host: What are some of the common symptoms of ulcerative colitis? Dr. Malhotra: So, I usually divide up the symptoms into GI and non-GI related symptoms, because the inflammation can actually affect really any part of your body. So, GI-wise, patients may present with abdominal pain, diarrhea, bloody diarrhea, nocturnal diarrhea - meaning they are waking up at night to have a bowel movement, tenesmus - meaning they have feelings of incomplete evacuation and have to keep going back to the bathroom constantly, and severe urgency. And then the non-GI symptoms may be related to inflammation of other body parts. They could have severe arthritis - which is inflammation of the joints. They could have uveitis or episcleritis - which is inflammation of the eye. They could have skin rashes. So, a whole slew of symptoms. Host: Can ulcerative colitis be serious or life threatening? Dr. Malhotra: Yes. So, let’s talk about short term. Untreated disease, first of all, is a huge burden on the patient. They can have debilitating symptoms and therefore, it’s not just a burden on their workforce where they are forced to miss work due to their symptoms but also, you know, people miss out on their social and family life. So there is the personal, social and financial impact. But then there’s untreated or complicated disease that can certainly become bad enough to require urgent or emergent surgery and hospitalization. So we always try to avoid a situation where an emergency surgery may be needed. Patients may need emergency surgery for refractory bleeding where their colon is bleeding so much that they may be exsanguinating. They can get a toxic megacolon where the colon swells up and does not function and can cause life threatening infection if not taken out emergently. So those are sort of the short term serious, life threatening implications. Long term, the risk of untreated ulcerative colitis is a huge risk of cancers. So, untreated disease puts patients at risk of colon cancer almost 8-fold compared to someone without ulcerative colitis. And non-colon related patients are at risk for developing something called PSC, which is primary sclerosing cholangitis. It’s inflammation and scarring of the bile ducts and it puts them at risk for a bile duct cancer called cholangiocarcinoma as well as gallbladder cancers. So really, long term and short term implications on their health. Host: Could you tell us a little bit about your patient population for ulcerative colitis? Dr. Malhotra: Sure, ulcerative colitis has a bimodal peak of incidence, so patients may present in their mid to late teens all the way up to early thirties. And then there’s a second peak with patients in their 50s to early 60s Host: So often ulcerative colitis begins gradually and then gets worse. How is it diagnosed? Dr. Malhotra: So actually, about a third of patients may present with mild disease and continue to have mild disease throughout the course of the disease. A third of patients may present with mild disease and at some point gradually or sometimes all of a sudden worsen to have severe disease. And about a third of patients may present with severe or even what we call fulminant disease, where they need emergent hospitalization, aggressive therapy and sometimes even surgery immediately. So, diagnosis is based upon endoscopy and biopsy. So, most patients will need a colonoscopy. Sometimes we just do a flexible sigmoidoscopy if the colon is really inflamed and not go the entire length of the colon. And it’s really important to make sure that the patients, at the time of diagnosis and really at any point when their disease is worsening, don’t have a concurrent infection with clostridium difficile, which is C. diff. C. diff is a bacteria that’s increasing in the community in general, but it’s present in patients with colitis in a significant more proportion than patients without colitis. And, the presence of C. diff makes ulcerative colitis more difficult to treat. It increases the risk of getting hospitalization and the risk of getting an urgent colectomy. Host: What medical treatments are available for ulcerative colitis? Dr. Malhotra: There actually many treatments available today. Mesalamine, which is a very old drug and we still use it in practice, is used for mild disease as first line therapy. Then there’s immunomodulators, such as Azathioprine or 6-mercaptopurine, which modulate, as their name suggests, modulate the immune system. So they decrease inflammation over time. We’re sort of steering away from those medications as first line as better and improved drugs are available on the market. And then there is biologics, which are medications that bring down inflammation and actually help heal the lining of the colon. And in reality, since the advent of these biologics, the face of colitis has changed. Less patients are getting surgery and more patients are achieving healing. The first biologic that was approved was infliximab. Now it’s been on the market for almost 18 years and it works very well in patients with colitis. And then there’s two other similar biologics - adalimumab and golimumab. There was another mechanism of drug that was approved in 2014 called vedolizumab which works completely different and, again, works really well in colitis. So, overall, we have a lot of medications. We are also anticipating approval of two new medications with different mechanism of action, hopefully this year - tofacitinib, which is a jak inhibitor and ustekinumab, which is actually approved in Crohn's disease and is hopefully going to be approved for ulcerative colitis as well. Host: Is surgery an option to cure ulcerative colitis? Dr. Malhotra: Yes. Removing the colon is actually curative of ulcerative colitis. We usually reserve a colectomy, a removing the colon, for patients who are not responding to our best medications or they’re extremely sick and their chances of responding to a medication is very low. But, I always tell my patients, getting surgery to remove colon is not failure of treatment - it’s just another modality of treatment. Surgery is done best when it’s planned. So, emergent surgery can sometimes be difficult as it can involve up to 3 procedures for the patient to complete the surgery and can even involve having a temporary ileostomy. But yes, in short, removing the colon is curative of ulcerative colitis. I do want the listeners to be aware that primary sclerosing cholangitis, which is inflammation of the bile ducts, can still happen or occur as a complication of ulcerative colitis, even years after their colon is taken out. So, even if they’ve had a colectomy, it’s important for them to follow up with their GI provider at least once a year to make sure that it’s not a complication they’re developing. Host: When you have patients who you recommend surgery - what is their emotional state, what is their mental state, when you recommend that they have their colon removed? Dr. Malhotra: You know, nobody wants to hear that they need emergency surgery or part of their organs removed. The good thing about the colon is we don’t really need the colon for any nutritional support. The colon’s there to absorb water. Now, that being said, of course we are finding  more and more that the microbiome, which is the life of bacteria, fungi and viruses that live in our colon, have a lot to do with our overall health. So maybe there are some long term implications of getting your colon taken out that we don’t recognize to date. However, studies have actually been done in patients who did undergo a colectomy for their colitis, and most of those patients, in retrospect, were relieved after the surgery as they got their life back. They lived a better, fuller life. And most of the patients did respond saying that they wish they had gotten the surgery earlier. Host: Could you share a story about a patient who had a poor prognosis and you were able to help them? Dr. Malhotra: I saw a young lady, in her late 20s, single mom, she’d been battling with ulcerative colitis for many years, and because of social issues had very fragmented care and had been on steroids for many years. As we know, we’re really deviating away from using steroids. Steroids have long lasting implications on a person’s body and health overall. I saw her when she was first admitted to the hospital. She was anemic, losing weight, having 20 bowel movements a day and just very depressed, understandably so, from her disease. We actually had our surgeons also see her because we were worried she may need a colectomy, but we initiated infliximab. She did extremely well with two treatments, was able to be discharged from the hospital, four months later, I just recently saw her in clinic. She’s doing great. She’s off of steroids and she actually has a part-time job and was just out of her depression and it just felt really good to see her getting her life back. Host: Are you conducting any research regarding ulcerative colitis that people in the community should know about? Dr. Malhotra: Yes. We’re currently partnered with Georgetown University Hospital to bring trials to Washington Hospital Center. We just completed enrolling for a trial for ustekinumab for ulcerative colitis, which we have completed enrollment at this time. We currently have a trial looking at the new drug filgotinib, both for ulcerative colitis and Crohn's disease. We’re also just about to start a trial looking at stem cell treatment for Crohn's disease with perianal involvement. And we’re also looking at novel ways to treat colitis that’s being caused by immunotherapy.  Immunotherapy-induced colitis appears very similar to ulcerative colitis and so we’re looking at novel ways to treat that colitis, as well. Host: Why is MedStar Washington Hospital Center the best place for patients to seek care for ulcerative colitis? Dr. Malhotra: For diseases such as ulcerative colitis, which fall under the umbrella of inflammatory bowel disease, these conditions require very specialized and patient-oriented and patient-centered approach. We have a team of highly trained gastroenterologists with advanced training in inflammatory bowel disease, as well as a group of highly trained colorectal surgeons. We work together in a multidisciplinary approach for these complicated patients. Host: Thanks for joining us today. Dr. Malhotra: Thank you. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

In this episode I cover liver transplants.If you want to follow along with written notes on liver transplants go to zerotofinals.com/livertransplant or find the gastroenterology section in the Zero to Finals medicine book.This episode covers the types of liver transplant, indications, contraindications, liver transplant surgery and the post transplantation care.The audio in the episode was expertly edited by Harry Watchman.

In today's VETgirl online veterinary continuing education podcast, we review liver toxicity secondary to azathioprine administration in dogs. Azathioprine is an immunosuppressive medication that has been gaining popularity in the veterinary community. It is a purine analog that can take up to 6 weeks to take effect (Plumb), and it is often used as a treatment for immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), immune-mediated polyarthritis, inflammatory bowel disease, and other immune-mediated conditions. Some practitioners express discomfort using azathioprine due to its potential for adverse effects, such as hepatotoxicity and bone marrow toxicity. But how worried should we be?

In today's VETgirl online veterinary continuing education podcast, we review liver toxicity secondary to azathioprine administration in dogs. Azathioprine is an immunosuppressive medication that has been gaining popularity in the veterinary community. It is a purine analog that can take up to 6 weeks to take effect (Plumb), and it is often used as a treatment for immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), immune-mediated polyarthritis, inflammatory bowel disease, and other immune-mediated conditions. Some practitioners express discomfort using azathioprine due to its potential for adverse effects, such as hepatotoxicity and bone marrow toxicity. But how worried should we be?

A study in the March 2015 issue of CGH finds that withdrawal of immunomodulators after at least 6 months of co-treatment with infliximab does not reduce the trough levels of infliximab in patients with Crohn's disease.

This podcast contains all you need to know about the medical management of severe ulcerative colitis, from definitions, treatments, toxic megacolon, when to call the surgeon and many other things you will find useful to know whether a medical student, trainee in medicine or trainee in surgery. It is longer than many other podcasts from School of Surgery, but well worth the time, so make yourself a cup of tea and settle down to listen to Jon Lund talk to Bod Goddard about severe ulcerative colitis. Andrew "Bod" Goddard is a consultant gastroenterologist and Jon Lund a consultant colorectal surgeon, both working at the Royal Derby Hospital, UK

Two related studies in the October issue of Gastroenterology look at early administration of azathioprine in the management of patients with Crohn's disease.

A combination of prednisone, azathioprine, and N-acetylcysteine has been widely used as a treatment for idiopathic pulmonary fibrosis, however the safety and efficacy of this three-drug regimen is unknown. Jennifer Quint, Thorax’s Journal Club editor, talks to Fernando Martinez, Professor, Department of Internal Medicine, University of Michigan, Ann Arbor, about the controversy surrounding the question, and what his paper on it reveals.See also:http://www.nejm.org/doi/full/10.1056/NEJMoa1113354

Drs. Stephen Harrison and Harpreet Dhaliwal Azathioprine (AZA) is used to maintain remission in autoimmune hepatitis (AIH), but up to 18% of patients are unresponsive. AZA is a prodrug, and the formation of active thioguanine nucleotide (TGN) metabolites varies widely. We aimed to assess the relationship between AZA metabolite concentrations (i.e., TGNs and methylmercaptopurine nucleotides [MeMPNs]), thiopurine methyltransferase (TPMT) activity, therapeutic response, and toxicity in adult patients with AIH prescribed a stable dose of AZA for the maintenance of remission. Red blood cell (RBC) TGNs and MeMPNs were measured in serial blood samples over a 2-year period. The average TGNs (avTGNs) and MeMPNs (avMeMPNs) concentrations for each patient were used for analysis. Therapeutic response was defined as the ability to maintain remission, defined as a normal serum alanine aminotransferase (ALT) level (ALT 220 pmol/8 × 108 RBCs best predicted remission, with an odds ratio of 7.7 (P = 0.003). There was no association between TGN, MeMPN, or TPMT activity and the development of leucopenia. Two patients developed AZA-induced cholestasis and the avMeMPN concentration was higher in those patients, compared to those who did not (14,277 versus 1,416 pmol/8 × 108 RBCs). Conclusion: TGN concentrations of >220 pmol/8 × 108 RBCs are associated with remission. TGN measurement may help identify inadequate immunosupression. AZA-induced cholestasis was associated with increased MeMPN concentrations.