Podcasts about infectious disease society

Dean's Chat hosts, Drs. Jeffrey Jensen and Johanna Richey welcome Dr. David Armstrong to the podcast.  This discussion wasn't about the "Diabetic Foot" as much as it was getting to know what makes the world leader in "Diabetic Foot" click.  His background and fascination with technology, intro to podiatry (he considered law) to transforming clinical opportunities at Kern Hospital and UT- San Antonio.   Dr. Armstrong is Distinguished Professor of Surgery and Neurological Surgery with Tenure at the University of Southern California. Dr. Armstrong holds a Master of Science in Tissue Repair and Wound Healing from the University of Wales College of Medicine and a PhD from the University of Manchester College of Medicine, where he was appointed Visiting Professor of Medicine. He is founder and co-Director of the Southwestern Academic Limb Salvage Alliance (SALSA).  Dr. Armstrong has produced more than 720 peer-reviewed research papers in dozens of scholarly medical journals as well as over 120 books or book chapters. He is founding co- Editor of the American Diabetes Association's (ADA) Clinical Care of the Diabetic Foot, now in its fourth edition.  Armstrong is Director of USC's National Science Foundation (NSF) funded Center to Stream Healthcare in Place (C2SHiP) which places him at the nexus of the merger of consumer electronics, wearables, and medical devices in an effort to maximize hospital-free and activity-rich days. Dr. Armstrong was selected as one of the first six International Wound Care Ambassadors and is the recipient of numerous awards and degrees by universities and international medical organizations including the inaugural Georgetown Distinguished Award for Diabetic Limb Salvage. In 2008, he was the 25th and youngest-ever member elected to the Podiatric Medicine Hall of Fame. He was the first surgeon to be appointed University Distinguished Outreach Professor at the University of Arizona. He was also the first podiatric surgeon to be selected as President of Faculty at Keck School of Medicine of USC. Furthermore, he was the first podiatric surgeon to become a member of the Society of Vascular Surgery, and the first US podiatric surgeon named fellow of the Royal College of Surgeons, Glasgow. He is the 2010 and youngest ever recipient of both the ADA's Roger Pecoraro Award and 2023 recipient of the ISDF's Karel Bakker Award, the highest awards given in the field. Dr. Armstrong is past Chair of Scientific Sessions for the ADA's Foot Care Council, and a past member of the National Board of Directors of the American Diabetes Association. He sits on the Infectious Disease Society of America's (IDSA) Diabetic Foot Infection Advisory Committee and is the US appointed delegate to the International Working Group on the Diabetic Foot (IWGDF). Dr. Armstrong is the founder and co-chair of the International Diabetic Foot Conference (DF-Con), the largest annual international symposium on the diabetic foot in the world. He is also the Founding President of the American Limb Preservation Society (ALPS), a medical and surgical society dedicated to building interdisciplinary teams to eliminate preventable amputation in the USA and worldwide. https://limbpreservationsociety.org/ https://bakodx.com/ https://bmef.org/ www.explorepodmed.org https://podiatrist2be.com/  

Send us a textIn this conversation, Dr. Paul Offit and pediatrician Jessica Hochman discuss the importance of vaccinations, the challenges of vaccine hesitancy among parents, and the need for nuanced conversations in public health. They explore the impact of the COVID-19 pandemic on public trust, and the science behind vaccination schedules. The discussion emphasizes the importance of understanding parental concerns while advocating for the safety and efficacy of vaccines. About Paul A. Offit, MD!Paul A. Offit, MD, is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children's Hospital of Philadelphia. He is the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania.Dr. Offit is an internationally recognized expert in the fields of virology and immunology, and was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. He is a member of the Food and Drug Administration Vaccines and Related Biological Products Advisory Committee, and a founding advisory board member of the Autism Science Foundation and the Foundation for Vaccine Research, a member of the Institute of Medicine and co-editor of the foremost vaccine text, Vaccines.He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, a Research Career Development Award from the National Institutes of Health, and the Sabin Vaccine Institute Gold Medal.Dr. Offit has published more than 160 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC. For this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases, and he was honored by Bill and Melinda Gates during the launch of their Foundation's Living Proof Project for global health.In 2009, Dr. Offit received the President's Certificate for Outstanding Service from the American Academy of Pediatrics. In 2011, he received the Humanitarian of the Year Award from the BiologicDr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. For more content from Dr Jessica Hochman:Instagram: @AskDrJessicaYouTube channel: Ask Dr JessicaWebsite: www.askdrjessicamd.com-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20-To test your child's microbiome and get recommendations, check out: Tiny Health using code: DRJESSICA Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

This week on Health Matters, Courtney Allison is joined by infectious disease expert from NewYork-Presbyterian and Columbia, Dr. Marcus Pereira, to learn what we need to know about bird flu.Dr. Pereira explains that while the cases of bird flu in humans have been mostly mild, there is still a risk that the virus could mutate and spread more easily from human-to-human. He talks about ways to protect ourselves from bird flu, and explains whether it's safe to eat eggs, meat and other dairy products.___Dr. Marcus Pereira is an Associate Professor of Medicine at CUMC and the Director of Clinical Services in the Division of Infectious Diseases. In addition, he is the Medical Director of the Transplant Infectious Diseases Program, where he oversees the development of infection prophylaxis and treatment protocols for immunocompromised patients. His areas of interest include the management of multi-drug resistant bacterial and fungal infections, as well as drug resistant CMV infections and more recently the impact of COVID-19 in transplant recipients. He has also collaborated in important multi-center studies as well as the 2025 International CMV Guidelines, sponsored by the Transplantation Society. Dr. Pereira is an active member in national societies such as the American Society of Transplantation and Infectious Disease Society of America, and is an Associate Editor for the American Journal of Transplantation.___Health Matters is your weekly dose of health and wellness information, from the leading experts. Join host Courtney Allison to get news you can use in your own life. New episodes drop each Wednesday.If you are looking for practical health tips and trustworthy information from world-class doctors and medical experts you will enjoy listening to Health Matters. Health Matters was created to share stories of science, care, and wellness that are happening every day at NewYork-Presbyterian, one of the nation's most comprehensive, integrated academic healthcare systems. In keeping with NewYork-Presbyterian's long legacy of medical breakthroughs and innovation, Health Matters features the latest news, insights, and health tips from our trusted experts; inspiring first-hand accounts from patients and caregivers; and updates on the latest research and innovations in patient care, all in collaboration with our renowned medical schools, Columbia and Weill Cornell Medicine. To learn more visit: https://healthmatters.nyp.org

Dr. Debra Bogen, Secretary of Health for the Commonwealth of Pennsylvania and an ASTHO Member, discusses ASTHO's Maternal and Childhood Health Legislative Prospectus; Dr. Tina Tan, President of the Infectious Disease Society of America, tells us how public health can push back against pertussis; an ASTHO blog article explores how mathematical models and forecasts predict outbreaks and guide public health decisions; and ASTHO Member Dr. Betsy Tilson was awarded the Public Service Award from the North Carolina Academy of Family Physicians. ASTHO Web Page: Supporting Maternal and Child Health Across All Stages of Life NBC News Article: Whooping cough spikes, especially among unvaccinated teens ASTHO Blog Article: Defining Disease Forecasting and Modeling  

Unfortunately, there simply isn't a one-size-fits-all treatment protocol for patients infected with Lyme disease and/or co-infections. This is why it's critical for physicians treating Lyme disease to invest time with patients, thoroughly understand their medical history, and closely monitor symptoms and treatment response. With that in mind, there are currently two different treatment approaches for Lyme disease. The Infectious Disease Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS) have each published their own set of evidence-based treatment guidelines. IDSA guidelines recommend a short course of antibiotics, typically 14 to 30 days. IDSA argues that the Borrelia burgdorferi bacteria do not persist in a patient beyond this timeframe and that lingering symptoms are the result of an ongoing immune response and not an active infection. It also cites scientific evidence claiming treatments beyond 30 days are ineffective, unnecessary, and even dangerous. IDSA physicians will stop treatment after 30 days, even if symptoms remain. They advise an additional 30 days of treatment recommended for patients with Lyme arthritis.  On the contrary, ILADS offers its own scientific data to show that a additional treatment with antibiotics is required to eradicate the bacteria. ILADS recognizes that a month of treatment may be sufficient for patients in the acute stage of Lyme disease, but in cases where the spirochete has disseminated and the disease has advanced, a 30-day treatment regimen is inadequate. ILADS guidelines recommend additional antibiotics until a patient's symptoms have been resolved. Treating Lyme disease in its advanced stage can be complicated based on the complexity of the organism itself, differences in each patient's immune system, the length of time infected, and the possible presence of other co-infections transmitted by the same tick. There are several choices in treating Lyme disease, which include oral, intravenous, and intramuscular antibiotic options. Other options may include sequential antibiotic therapy, higher doses of antibiotics, taking antibiotics for a longer period of time, a combination of antibiotics, retreatment, as well as diagnosing and treating co-infections. Some specific antibiotics used in treating Lyme disease are doxycycline, minocycline, amoxicillin, cefuroxime, azithromycin, and clarithromycin. Other tests include measures of blood counts, chemistries, liver function tests, ANA, dsDNA, RF, TSH, free T3, free T4, ESR may be helpful at ruling out other conditions.  Referral to specialist might help to rule out other conditions.  I find shared decision with my patient helpful. I also find follow-up helpful to assess my patient's response to treatment to rule out other conditions. There are additional protocols that may also aid in treating Lyme disease, such as avoiding alcohol, simple and processed sugars, exercising as tolerated, counseling for a Jarisch-Herxheimer reaction, managing symptoms, monitoring and reducing the risk of an adverse event, and reducing stress. However, there is a chance of side effects such as Clostridium difficile-associated diarrhea (CDAD). Probiotic have been prescribed with the hope of reducing the risk of developing CDAD.   

Drug resistance to antibiotics continues to escalate. This week we do a deep dive into the Infectious Disease Society of America's (IDSA) brand new guidance on the treatment of antimicrobial resistant gram-negative infections.  The GameChangerThe new IDSA guidelines provide critical, evidence-based recommendations for managing drug-resistant gram-negative infections. The guidance offers health care providers clear strategies to improve outcomes and reduce the emergence of resistance.HostJen Moulton, BSPharmPresident, CEimpactGuests Geoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint HealthAmanda Bushman, PharmD,BCPS-AQ ID, BCIDP, FIDSAInfectious Disease PharmacistUnityPoint HealthTony Mannum, PharmDPGY2 Infectious Disease ResidentUnityPoint HealthReferenceIDSA Guidelines for treating resistant gram negative organismsPharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/CPE InformationLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Identify effective strategies for treating urinary tract and systemic infections caused by Extended-Spectrum Beta-Lactamase (ESBL)-producing organisms.2. Discuss appropriate therapeutic agents for infections caused by AmpC beta-lactamase-producing bacteria, ensuring choices minimize the risk of resistance development during treatment.0.05 CEU/0.5 HrUAN: 0107-0000-24-251-H01-PInitial release date: 09/02/2024Expiration date: 09/02/2025Additional CPE details can be found here.

Drug resistance to antibiotics continues to escalate. This week we do a deep dive into the Infectious Disease Society of America's (IDSA) brand new guidance on the treatment of antimicrobial resistant gram-negative infections.  The GameChangerThe new IDSA guidelines provide critical, evidence-based recommendations for managing drug-resistant gram-negative infections. The guidance offers health care providers clear strategies to improve outcomes and reduce the emergence of resistance.Guests Geoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint HealthAmanda Bushman, PharmD, BCPS-AQ ID, BCIDP, FIDSAInfectious Disease PharmacistUnityPoint HealthTony Mannum, PharmDPGY2 Infectious Disease ResidentUnityPoint HealthReferenceIDSA Guidelines for treating resistant gram negative organisms Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Identify effective strategies for treating urinary tract and systemic infections caused by Extended-Spectrum Beta-Lactamase (ESBL)-producing organisms.2. Discuss appropriate therapeutic agents for infections caused by AmpC beta-lactamase-producing bacteria, ensuring choices minimize the risk of resistance development during treatment.0.05 CEU/0.5 HrUAN:  0107-0000-24-251-H01-PInitial release date: 09/02/2024Expiration date: 09/02/2025Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

Welcome! Today, we're exploring the key milestones in Lyme disease research and treatment.I had a 57-year-old patient who remained chronically ill after being diagnosed and treated for Lyme disease. He didn't realize that a persistent tick-borne infection could explain his chronic illness. He was treated with a combination of azithromycin and atovaquone for the persistent infection, and today, he is doing well.He was surprised that, despite the milestones in Lyme disease research, he wasn't aware that a persistent infection could lead to his chronic illness. So, let's take a closer look at these milestones.1. 1977: Discovery of Lyme DiseaseOur story begins in 1977 in Lyme, Connecticut. A cluster of children and adults were diagnosed with what was initially thought to be juvenile rheumatoid arthritis. This event marked the identification of Lyme disease as a distinct illness and the start of modern Lyme disease awareness."2. 1982: Discovery of the Bacterium Responsible for Lyme DiseaseIn 1982, Dr. Willy Burgdorfer identified Borrelia burgdorferi, the bacterium responsible for Lyme disease. This discovery was a major milestone, enabling more precise identification and treatment of the disease. 3. 1990: Recognition of Chronic Lyme DiseaseBy 1990, chronic Lyme disease, with its long-term and persistent symptoms, was officially recognized. This led to more comprehensive treatment protocols and increased awareness of the disease's chronic nature.4. 1995: Discovery of Babesia microtiIn 1995, Babesia microti was identified as a co-infection transmitted by the same ticks that carry Lyme disease. This highlighted the complexity of tick-borne illnesses and the need for integrated treatment approaches. 5. 2000: Publication of IDSA and ILADS GuidelinesThe year 2000 saw the publication of treatment guidelines by both the Infectious Disease Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS). These guidelines showcased different approaches to treating Lyme disease, marking another significant milestone. 6. Ongoing Research and Future Milestones Research is ongoing, and we look forward to future milestones that could lead to breakthroughs in diagnosis and treatment. Studies on biofilms, persisters, and tick-borne co-infections may enable doctors to develop treatment plans that significantly improve patient outcomes.ConclusionUnderstanding these milestones helps us appreciate the progress made in the fight against Lyme disease. With continued research and dedication, we move closer to effective management and potential cures. Thank you for watching, and stay tuned for more insights on Lyme disease." 

• Background of Dr. John Lambert: Dr. John Lambert was born in Scotland, parents immigrated to America, thus obtaining an American education. Returned to the UK in 1999 before settling in Dublin, Ireland shortly after. Working as an infectious disease and Lyme specialist for 18 years. • Education & Professional Journey: College in Kalamazoo, Michigan. Attended University of Sterling in Scotland. Expressed the challenges of transitioning between countries. Always had an inclination towards medical school, initially interested in tropical medicine. Work experience in Haiti at a Mission Hospital. • Infectious Disease Conferences & Updates: Attended a recent Infectious Disease Society of America (IDSA) conference in Boston. Updates on Lyme, coronavirus, HIV/AIDS, tropical medicine, and vaccine developments. • Intricacies of Infectious Diseases: The dual excitement of diagnosing and treating infectious diseases, like Lyme disease. The significance of monitoring patients. Emphasis on evidence-based treatments and results. • Publications and Expertise: Dr. Lambert's 25+ publications. The importance of verifying experts through PubMed searches. The challenges of diagnostics in the Lyme community. • Defining Lyme Disease: Tick Boot Camp provides Tick Boot Camp's definition of Lyme disease. Dr. Lambert's perspective on the definition and the polymicrobial nature of Lyme. • Treatment Guidelines and Controversies: Irish guidelines on Lyme treatment. The debate on chronic Lyme and the skepticism surrounding it. • Immune System Implications: Lyme disease's dual impact on the immune system: immune suppression and potential autoimmune reactions. Discussion on the potential similarities and differences between Lyme disease and other conditions like long COVID. • Diagnostic Tools and Collaborations: Collaboration with Dr. Samiy from the University of North Carolina State. Newer diagnostic tools and their significance. • Treatment Modalities and Approaches: The utilization of LDN (Low Dose Naltrexone) and NAC (N-acetyl cysteine). The importance of maintaining a healthy microbiome. Dr. Lambert's collaborative approach, working alongside herbalists. • Final Thoughts: Emphasizing the bacterial nature of Lyme disease. The importance of timely diagnosis and appropriate treatment.

In this episode, we discuss the evaluation of fever in the adult ICU patient. We discuss updates from the recently published Society of Critical Care Medicine and Infectious Diseases Society of America clinical guidelines. My guest is Dr. Andre Kalil, a critical care and infectious disease physician. Dr. Kalil is a Professor in the Division of Infectious Disease and Director of Transplant Infectious Disease at the University of Nebraska Medical Center (UNMC). A renowned clinician, educator, and researcher, Dr. Kalil has received many distinctions, including the 2021 Scientist Laureate Award at UNMC. Dr. Kalil is an author of the 2023 Society of Critical Care Medicine and The Infectious Disease Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU.

Have y'all heard of CRISPR?? This revolutionary gene-editing technology has the potential to treat and possibly CURE genetic diseases. Recently an FDA advisory committee has recommended the use of this technology in efforts to cure symptoms of sickle cell disease in people! THIS IS HUGE NEWS! In today's episode, Jeremy presents the context and backstory of sickle cell disease, and the ripple effects of using gene-editing therapy to treat it effectively. This could be a real game-changer for folks living with sickle cell disease, who only have access to supportive care measures to treat the devastating, and frequently deadly effects of this debilitating genetic disorder. Your Doctor Friends are excited, and you should be too! WE ARE LIVING IN THE FUTURE, FRIENDS! The FDA's final decision on its approval of "exa-cel", the groundbreaking gene-editing technique to treat sickle cell disease is scheduled for December 8, 2023, right around the corner! Stay tuned folks, you can bet that Your Doctor Friends will cover more stories about this amazing leap in treatment for genetic disorders! Finally, stay tuned til the end for a little "dessert" health headline story from Julie about using leftover antibiotics; the reason why people do it, and what the ramifications could be. Resources for today's episode include: A New York Times article "Panel Says That Innovative Sickle Cell Cure Is Safe Enough for Patients". A Doc Wire News article "FDA Advisory Committee Endorses Safety of Exa-Cel in SCD". The NIH website's page on "What Is Sickle Cell Disease?" An article by the Infectious Disease Society of America outlining how antibiotics are "like gold" to some patients, discussing how personal beliefs and health care barriers drive inappropriate antibiotic use. For more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link! This includes the famous "Advice from the last generation of doctors that inhaled lead" shirt :) Also, CHECK OUT AMAZING HEALTH PODCASTS on The Health Podcast Network   Find us at: Website: yourdoctorfriendspodcast.com  Email: yourdoctorfriendspodcast@gmail.com  Connect with us: @your_doctor_friends (IG) Send/DM us a voice memo/question and we might play it on the show! @yourdoctorfriendspodcast1013 (YouTube) @JeremyAllandMD (IG, FB, Twitter) @JuliaBrueneMD (IG) @HealthPodNet (IG)

Episode 155: Diabetic Foot Infection GuidelinesFuture Dr. Perez presents the updates on lung cancer screening by the American Cancer Society. Future Dr. Danusantoso explains the classification, diagnosis, and treatment of diabetic foot infections according to the guidelines published by the International Working Group on the Diabetic Foot (IWGDF). Dr. Arreaza adds comments and anecdotes.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Intro: Lung cancer screening update.Written by Luz Perez, MSIII, Ross University School of Medicine. Editing by Hector Arreaza, MD.Hello, my name is Luz Perez and today I will talk about lung cancer screening.As a reminder, lung cancer is the top cause of cancer-related death in men and women worldwide. In the United States, lung cancer causes the death of about 154,000 people each year[4]. Smoking is the most significant risk factor for developing lung cancer, a risk that directly correlates to how much and how long a person has smoked[2]. Despite the efforts to decrease lung cancer-related deaths, which include screening of patients at risk and counseling on smoking cessation, many patients go undiagnosed in part because lung cancer can be asymptomatic but also because many people at risk did not meet the criteria for screening, according to previous guidelines… BUT On November 1, 2023, the American Cancer Society updated its guidelines for lung cancer screening to decrease mortality by lung cancer in the US. The updated lung cancer screening guidelines were published in November, which is Lung Cancer Awareness Month. This guideline aims to expand eligibility criteria for lung cancer screening. Previously, the guidelines covered people only between the ages of 55-74 who were current smokers or had quit within the past 15 years and had a 30 or more pack-year smoking history[3].The new guidelines recommend annual screening with low-dose CT (LDCT) scan for people who are 50-80 years old who are current or former smokers and who have a 20 or more pack-year of smoking history [1]. This change means that about 5 million people who would previously not qualify for screening are now eligible for this potentially lifesaving screening exam.Additionally, the American Cancer Society emphasizes the significance of shared decision-making between patients and healthcare providers on lung cancer screening and smoking cessation. This includes ways to help patients stop smoking by providing counseling and interventions including medications. For patients who are eligible for screening, having a full discussion of the lung cancer screening process including the purpose of the procedure, risks and benefits of low-dose CT, and recommendations from other organizations, is key in the shared decision-making process[1]. Perhaps, the most important step in the implementation of these new guidelines is ensuring that medical professionals talk to their patients about them and make them aware of the importance of screening for lung cancer. In this way, we can reduce mortality and other consequences of this devastating disease. Written by Maria Danusantoso, MSIV, Ross University School of Medicine. Editing by Hector Arreaza, MD.Update to Guidelines for Treatment of Diabetic Foot InfectionsIntroductionIn October 2023, the International Working Group on the Diabetic Foot (IWGDF) and the Infectious Disease Society of America (IDSA) collaborated and published an update to the 2019 guideline on the diagnosis and management of infections of the foot in persons with diabetes mellitus.The present guidelines include a list of 25 recommendations for diagnosis and management and clinically useful figures and tables including a treatment algorithm, a classification system for defining diabetic foot infections, and empirical antibiotic therapy according to clinical presentation and microbiological data.The goal of this episode is not to provide an exhaustive review of the updated guidelines and algorithms but to highlight what I believe are the most important recommendations. I hope this brief presentation is viewed as an introduction and that this encourages you, the listener, to independently read the guidelines in full and implement them into your own clinical practice.Wound Colonization Versus Wound InfectionBefore jumping into some of the recommendations, I want to take some time to discuss briefly how to classify diabetic foot infections. Most clinicians, including myself, will see a patient with diabetes with a foot ulcer or wound and want to treat it with antibiotics or admit the patient to the hospital. However, the updated guidelines propose that antibiotics and/or admission are not always indicated. For clinicians, there needs to be an awareness that wound colonization and wound infection are not the same. Wound colonization by bacteria is defined by the presence of bacteria on a wound surface without evidence of invasion of the host tissues. Colonization, then, can be considered a constant phenomenon as we live in a bacteria-filled world. Comment: If we culture our intact skin, we may find pathogens, that's why wound cultures even if they are positive, do not indicate there is infection. Tell us about infection.In contrast, wound infection is a disease state caused by the invasion and multiplication of microorganisms in host tissues that induce an inflammatory response in the host, usually followed by tissue damage. Therefore, since all wounds are colonized – often with potentially pathogenic microorganisms – we cannot define wound infection using only the results of wound cultures. Instead, diabetic foot infections are a clinical diagnosis based on the presence of manifestations of an inflammatory process involving a foot wound located below the malleoli. These signs and symptoms of inflammation may be masked in persons with diabetes especially if they have some level of baseline peripheral neuropathy, peripheral artery disease, or immune dysfunction.Classification of Diabetic Foot Infections.To assist with the classification of diabetic foot infections, the updated guidelines include a table for defining the presence and severity of an infection of the foot in a person with diabetes. Again, diabetic foot infections are a clinical diagnosis, and the clinical classification of infection can be described as: 1) uninfected, 2) mild, 3) moderate +/- O if osteomyelitis is present, 4) severe +/- O if osteomyelitis is present. Uninfected has no systemic or local symptoms or signs of infection. Mild infection is when at least two of the following are present: local swelling or induration, erythema between 0.5-2 cm around the wound in any direction, local tenderness or pain, local increased warmth, purulent discharge, and there is no other cause of an inflammatory response of the skin present (e.g., trauma, gout, acute Charcot neuro-arthropathy, fracture, thrombosis, or venous stasis).Moderate infection is without systemic manifestations and involves erythema extending 2 cm or more from the wound margin and/or involves tissue deeper than skin and subcutaneous tissues (e.g., tendon, muscle, joint, and bone) +/- the presence of osteomyelitis. The surrounding erythema and the depth of wound are key element in the classification of the wounds. Severe infection is associated with systemic manifestations and meets systemic inflammatory response syndrome (SIRS) criteria as manifested by 2 or more of the following: temperature below 36°C or above 38°C, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute, white blood cell count greater than 12,000/mm3 or greater than 10% immature (band) forms +/- presence of osteomyelitis. Features of Osteomyelitis on Plain X-RayWe have mentioned osteomyelitis quite a few times in this episode, so what are some ways we can diagnose osteomyelitis? Most commonly, osteomyelitis is diagnosed via imaging either with plain X-rays  or MRI. When looking at plain X-rays, there are a few features that are characteristic of diabetes-related osteomyelitis of the foot of which we should be aware regardless of our status as radiologists. Some of these features include bone sclerosis with or without erosion, abnormal soft tissue density or gas density in the subcutaneous fat, or new or evolving radiographic features on serial images spaced several weeks apart such as loss of bone cortex, focal demineralization, periosteal reaction or elevation. Changes in x-ray may be a late finding and indicate that the osteomyelitis is established.General Treatment Recommendations for Diabetic Foot InfectionsIn the updated guidelines, recommendation 11 states to not treat clinically uninfected foot ulcers with systemic or local antibiotic therapy when the goal is to reduce the risk of new infection or to promote ulcer healing. As previously said, diabetic foot infections are a clinical diagnosis. So if clinically the wound does not meet criteria to be classified as a mild, moderate, or severe infection, this recommendation proposes that no antibiotic treatment is the best treatment so as not to expose patients to potentially unnecessary and harmful treatment and to not promote antibiotic resistance in patients, which would potentially make treating diabetic foot infections more challenging in the future. We still want to very closely monitor the wound every 2-7 days and promote wound healing with pressure offloading, keeping the wound and the surrounding skin clean and dry, and other non-antibiotic management for local wound care.What are some common bacteria?.When it is indicated to treat diabetic foot infections per the guidelines, recommendation 14 states to target aerobic gram positive pathogens only for people with a mild diabetes related foot infection. These pathogens include beta hemolytic streptococci and Staphylococcus aureus including methicillin-resistant strains if indicated. Additionally, recommendation 15 advises not to empirically target antibiotic therapy against Pseudomonas aeruginosa in cases of diabetes-related foot infection in temperate climates. However, it is appropriate to use empirical treatment of P. aeruginosa if it has been isolated from cultures of the affected site within the previous few weeks or in a person with moderate or severe infection who resides in tropical/subtropical climates.Antibiotic Treatment Duration RecommendationThe final recommendation we have time to discuss in this episode is regarding antibiotic treatment duration. For mild infections, oral antibiotics (such as cephalexin or Bactrim) for a duration of 1-2 weeks is appropriate. However, if the infection is improving but is extensive and is resolving slower than expected or if the patient has severe peripheral artery disease, it is reasonable to consider extending treatment for up to 3-4 weeks.For moderate or severe infections without osteomyelitis, a total treatment duration of 2-4 weeks is recommended starting initially with IV antibiotics before transitioning to oral antibiotics. Antibiotic selection will depend on multiple factors, such as recent antibiotic use, or MRSA risk factors. For example, if the patient took antibiotics recently, they could receive Zosyn® and ceftriaxone. If osteomyelitis is present, antibiotic treatment duration can be anywhere from 2 days to 6 weeks depending on the amount of source control achieved. Ideally, we should wait to have bone resection before giving antibiotics, but we know that antibiotics are given promptly in the ER.In the cases of a resected infected bone or joint (when complete source control is achieved), a duration of 2-5 days is recommended, starting with IV antibiotics before transitioning to oral antibiotics. If there is minor amputation of the infected foot but there remains a positive wound culture or positive margins are seen on pathology (inflammatory cells are seen at the proximal margin of the amputated section), a 3-week antibiotic treatment duration is recommended, again starting with IV before transitioning to oral antibiotics.For diabetes-related foot osteomyelitis without bone resection or amputation, a 6-week course of antibiotics is recommended, again initially with IV antibiotics before transitioning to oral. In all the situations where there is a transition from IV to oral antibiotics, this transition may only occur once there are clinical signs of improvement, for example, improving erythema surrounding the wound, resolution of tenderness or purulent drainage, or SIRS criteria is no longer met.Summary: For more details regarding the 2023 update to the guidelines on the diagnosis and treatment of foot infection in persons with diabetes, please refer to the complete guidelines which can be accessed on the IWGDF Guidelines website and via the citations listed in the References. As a reminder, this podcast episode is not an exhaustive review of the guidelines, but, instead, a brief introduction to some of the recommendations. Thank you for listening and I hope you learned something new!_____________________________Conclusion: Now we conclude episode number 155 “Diabetic foot guidelines.” Future Dr. Perez started this episode with an introduction about the new guidelines to screen for lung cancer, then future Dr. Danusantoso gave an excellent summary about the classification and treatment of diabetic foot infections. Our patients with diabetes must have foot self-awareness and report any concerns to their family physicians or podiatrists so they can get prompt treatment.This week we thank Hector Arreaza, Luz Perez, and Maria Danusantoso. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:McDowell, Sandy, New Lung Cancer Screening Guideline Increases Eligibility. American Cancer Society, published on November 1, 2023, Cancer.org. https://www.cancer.org/research/acs-research-news/new-lung-cancer-screening-guidelines-urge-more-to-get-ldct.htmlWolf AMD, Oeffinger KC, Shih TY, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society [published online ahead of print, 2023 Nov 1]. CA Cancer J Clin. 2023;10.3322/caac.21811. doi:10.3322/caac.21811. Link: https://pubmed.ncbi.nlm.nih.gov/37909877/Moniuszko, Sara. Lung cancer screening guidelines updates by American Cancer Society to include more people. CBS News, updated on November 3, 2023. https://www.cbsnews.com/news/lung-cancer-screening-guideline-american-cancer-society-update/Deffebach, M. E., & Humphrey, L. (2023). Screening for lung cancer. UpToDate. Retrieved November 6, 2023, UpToDate. https://www.uptodate.com/contents/screening-for-lung-cancerÉric Senneville, Zaina Albalawi, Suzanne A van Asten, Zulfiqarali G Abbas, Geneve Allison, Javier Aragón-Sánchez, John M Embil, Lawrence A Lavery, Majdi Alhasan, Orhan Oz, Ilker Uçkay, Vilma Urbančič-Rovan, Zhang-Rong Xu, Edgar J G Peters, IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023), Clinical Infectious Diseases, 2023; ciad527, https://doi.org/10.1093/cid/ciad527Senneville, Éric et al. 2023. “IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Foot Infection in Persons with Diabetes.” IWGDF Guidelines. Retrieved November 6, 2023 (https://iwgdfguidelines.org/wp-content/uploads/2023/07/IWGDF-2023-04-Infection-Guideline.pdf). Royalty-free music used for this episode: Gushito, “Gista Mista”, downloaded on November 16th, 2023, from https://www.videvo.net/ 

Join your cohosts, Dr. Starlin and Sarah, as they interview attendees, speakers and students from the Nebraska Infectious Disease Society (NIDS) 2023 Annual Conference. Resources mentioned in this podcast: Nebraska Infectious Disease Society Website: https://www.idnebraska.org/ Nebraska Antimicrobial Stewardship Assessment and Promotion (ASAP) Program Website: https://asap.nebraskamed.com Podcast Microbios with Dr. Max Brito: https://asm.org/Podcasts/Microbios This podcast is brought to you by Nebraska ICAP. This team is grant funded to provide infection control and infectious disease support for facilities across Nebraska. You can find more information about Nebraska at https://icap.nebraskamed.com/ Don't forget to follow us on Twitter at @dirty_drinks and reach out to us if you want to be a guest on the show! The views expressed in this podcast are those of the guests and hosts. These views do not represent the official standing of any public, state or federal entity.

Rural healthcare has become a hub for innovation, and this week we engage in a conversation about, yet another way rural health is taking the lead with telementoring. Our next guest on Rural Health Leadership Radio is Dr. Wari Allison, a physician-scientist and director of the National Rural Telementoring Training Center. Wari shares her insights on leadership and the power of collaboration. In our conversation, we discuss the importance of addressing health disparities in rural America and how telementoring can help bridge the gap.  “Telementoring can be there to educate and skill build and it's fairly easy to access because all you need is telecommunications.” -Dr. Wari Allison Dr. Wari Allison directs the federally funded National Rural Telementoring Training Center and is VP of Health Policy at the University of North Texas Health Science Center Fort Worth and Executive Director of their Center for Health Policy. She is board certified in internal medicine and Infectious disease and holds a PhD in Public Health and Community Medicine. Dr. Allison is elected to fellowship of both the American College of Physicians and the Infectious Disease Society of America and is passionate about combating health inequities.

Paul A. Offit, MD, is Director of the Vaccine Education Center and professor of pediatrics in the Division of Infectious Diseases at Children's Hospital of Philadelphia. He is the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania. Dr. Offit is an internationally recognized expert in the fields of virology and immunology, and was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention. He is a member of the Food and Drug Administration Vaccines and Related Biological Products Advisory Committee, and a founding advisory board member of the Autism Science Foundation and the Foundation for Vaccine Research, a member of the Institute of Medicine and co-editor of the foremost vaccine text, Vaccines. He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, a Research Career Development Award from the National Institutes of Health, and the Sabin Vaccine Institute Gold Medal. Dr. Offit has published more than 150 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq®, recommended for universal use in infants by the CDC. For this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases, and was honored by Bill and Melinda Gates during the launch of their Foundation's Living Proof Project for global health. Read Dr. Offit's complete bio here: https://www.chop.edu/doctors/offit-paul-a _______________________________________________________ JOWMA Podcast | Ep. 1 How to Fool Yourself Less Often: Medical Decision Making for Regular People https://anchor.fm/jowma/episodes/Ep--1-How-to-Fool-Yourself-Less-Often-Medical-Decision-Making-for-Regular-People-eav2pu _______________________________________________________ Become a JOWMA Member! www.jowma.org  Follow us on Instagram! www.instagram.com/JOWMA_org  Follow us on Twitter! www.twitter.com/JOWMA_med  Follow us on Facebook! https://www.facebook.com/JOWMAorg/ Stay up-to-date with JOWMA news! Sign up for the JOWMA newsletter! https://jowma.us6.list-manage.com/subscribe?u=9b4e9beb287874f9dc7f80289&id=ea3ef44644&mc_cid=dfb442d2a7&mc_eid=e9eee6e41e

In this episode of Critical Matters, we discuss Central Nervous System (CNS) Infections. Our discussion focuses on the management of meningitis and encephalitis in the ICU. My guest is Dr. Catherine Albin, a neuro intensivist at the Emory Healthcare System in Atlanta, Georgia. Dr. Albin holds a faculty position as Assistant Professor of Neurology and Neurosurgery, in the Division of Neurocritical Care of Emory University School of Medicine. Additional Resources Infectious Meningitis and Encephalitis. R Bystritsky and F Chow: https://pubmed.ncbi.nlm.nih.gov/34798976/ Critical care management of meningitis and encephalitis: an update. M Thy, et al.: https://pubmed.ncbi.nlm.nih.gov/35975963/ Infectious Disease Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis: https://pubmed.ncbi.nlm.nih.gov/28203777/ Books Mentioned in this Episode The Acute Neurology Survival Guide. By Catherine Albin and Sahar Zafar :bit.ly/45Ttfuo Why We Sleep: Unlocking the Power of Sleep and Dreams. By Matt Walker: https://bit.ly/3MNoWs0

Pediatrics Now Host and Producer Holly Wayment interviews Dr. Mary Anne Jackson. A 1978 graduate of the UMKC School of Medicine, Dr. Mary Anne Jackson completed pediatric residency at Cincinnati Children's, and infectious diseases fellowship at the University of Texas Southwestern, before joining the faculty at Children's Mercy Kansas City in 1984. She has served as the Dean of the University of Missouri School of Medicine since 2018. Acknowledged locally, regionally, and nationally as an astute clinician and educator on pediatrics and pediatric infectious diseases topics, she is recognized for developing one of the most robust pediatric infectious diseases programs in the country and for educating thousands of students, residents, fellows, and faculty in pediatrics throughout her nearly 40-year career. In 2019, she was recognized with the American Academy of Pediatrics award for Lifetime Contribution in Infectious Diseases Education. A fellow of the American Academy of Pediatrics, the Infectious Disease Society of America, and the Pediatric Infectious Disease Society, she served as a member of the National Vaccine Advisory Committee from 2017-2021. She has also been elected to Alpha Omega Alpha Honor Society, the American Pediatric Society, the Society of Pediatric Research, and the Academic Pediatric Association.  She is a national thought leader in pediatric infectious disease topics and in 2014 with her colleagues at Children's Mercy, she identified the first cases of enterovirus D68 infection, leading to a CDC investigation that alerted pediatric providers around the country to the largest outbreak ever of this unique virus that led to respiratory failure and a post infection polio like syndrome in some children. Her research efforts have focused on characterization of Kawasaki disease, prevention of antibiotic resistance, judicious use of antibiotics, emerging viruses, and optimal use of vaccines. During the COVID-19 pandemic, she has served on advisory committees at the University, the state and national level.

In this episode of the MGC podcast, I talk to Dr. Gloria Dominguez, a world-renowned microbiome expert who has studied the pre- and postnatal influences on the developing gut microbiome, and the implications of this early development for health and disease. Dr. Dominguez is the Henry Rutgers Professor of Microbiome and Health at Rutgers University. She is the Director of the Institute for Food Nutrition and Health and a Fellow of the American Academy of Microbiology, and of the Infectious Disease Society of America. Her work centers and impacts exerted on the microbiome by urban practices, including practices that impair early life microbiota transmission and colonization -such as C-sections- and studying changes on microbiomes across urbanization gradients. Together with her husband Martin Blaser, she stars in the new, award winning documentary The Invisible Extinction, which is streaming on Amazon. In this podcast I talk to Dr. Dominguez about several fascinating topics, including: • The effect of mode of delivery on infant microbiome and health • Maternal-child microbial seeding interventions. • Early-life microbiome restoration • Influence of maternal diet on offspring • Gut microbiome and COVID-19 • The Microbiome Vault project Rather listen to this episode? Check it out here on YouTube: https://youtu.be/Ah30Mu8XN4Q Follow Dr. Mayer here: https://linktr.ee/emayer

In this episode of the MGC podcast, I talk to Dr. Gloria Dominguez, a world-renowned microbiome expert who has studied the pre- and postnatal influences on the developing gut microbiome, and the implications of this early development for health and disease. Dr. Dominguez is the Henry Rutgers Professor of Microbiome and Health at Rutgers University. She is the Director of the Institute for Food Nutrition and Health and a Fellow of the American Academy of Microbiology, and of the Infectious Disease Society of America. Her work centers and impacts exerted on the microbiome by urban practices, including practices that impair early life microbiota transmission and colonization -such as C-sections- and studying changes on microbiomes across urbanization gradients. Together with her husband Martin Blaser, she stars in the new, award winning documentary The Invisible Extinction, which is streaming on Amazon. In this podcast I talk to Dr. Dominguez about several fascinating topics, including: • The effect of mode of delivery on infant microbiome and health • Maternal-child microbial seeding interventions. • Early-life microbiome restoration • Influence of maternal diet on offspring • Gut microbiome and COVID-19 • The Microbiome Vault project Rather listen to this episode? Check it out here on YouTube: https://youtu.be/Ah30Mu8XN4Q Follow Dr. Mayer here: https://linktr.ee/emayer

The Department of Agriculture confirmed yesterday that a turkey flock in Monaghan has tested positive for avian flu. The Department confirmed that they will be putting in place a restriction zone to protect other flocks. Speaking to Newstalk Breakfast was Billy Gray, Owner of Feighcullen Farm, Producers of Ducks, Chickens, Turkeys and Geese, and Eoghan De Barra, Infectious Diseases Consultant Working in Beaumont Hospital and Secretary of the Infectious Disease Society of Ireland.

The Department of Agriculture confirmed yesterday that a turkey flock in Monaghan has tested positive for avian flu. The Department confirmed that they will be putting in place a restriction zone to protect other flocks. Speaking to Newstalk Breakfast was Billy Gray, Owner of Feighcullen Farm, Producers of Ducks, Chickens, Turkeys and Geese, and Eoghan De Barra, Infectious Diseases Consultant Working in Beaumont Hospital and Secretary of the Infectious Disease Society of Ireland.

In this week's episode we dig into the microbiome with world renowned expert Dr. Ghannoum.  We chat about what the microbiome is, and that is not JUST bacteria.  How the microbiome not just in your gut, the health implications of these colonies, what disrupts them and what feeds them.   No one has done more research of the microbiome that Dr G., and he continues to research more everyday.Dr G is the Co-Founder and Chief Scientific Officer, BiohmHealthReceived an MSc in Medicinal Chemistry and his PhD in Microbial Physiology from the University of Technology in Loughborough, England, and an MBA from the Weatherhead School of Management at Case Western Reserve University, Cleveland, OH. A tenured Professor and Director of the Integrated Microbiome Core and Center for Medical Mycology, and Case Western Reserve University and University Hospitals Cleveland Medical Center. Published > 450 peer reviewed publication and 6 scientific books, and was on the top 1% of cited Scientists Worldwide Established a multidisciplinary Center of Excellence that combines basic and translational research that spans test tube to the bedside capabilities. He pioneered studies on the fungal communities residing in and on our body and coined the term ‘Mycobiome”. Awarded the Rhoda Benham Award from the MMSA, and the Freedom to Discover Award from Bristol-Myers Squibb for his outstanding and meritorious contributions to the fields of medical mycology and microbial biofilms. Fellow of the Infectious Disease Society of America (IDSA), past President of the Medical Mycological Society of the Americas (MMSA). Fellow of the American Academy of Microbiology (FAAM), and the European Society of Clinical  Microbiology and Infectious Diseases (FESCMID).An entrepreneur-scientist who has launched a number of companies focused on the treatment of biofilm infections, as well as microbial dysbiosis.

Dr. Michael Dailey is the co-founder of the Infectious Disease Society of Georgia and Co-President of the Infectious Disease Society of America, a foundation on a mission to reduce the burdens of infectious diseases worldwide.He is Board Certified in Infectious Disease and Internal Medicine, a Fellow of the American College of Physicians, and has professional […]

In this week's episode, Chris speaks with Dr. Steven Berk; Dean, Executive VP, and Provost of Texas Tech University's Health Science Center, about his journey and philosophy as a leader. Drawing from his memoir “Anatomy of Kidnapping”, Dr. Berk recounts his struggle with working in between the healthcare system while trying to preserve the ethics of health workers. Dr. Berk talks about how he trusts his family and colleagues to keep him anchored and focused on doing the right thing.Sharing his harrowing story of being held at gunpoint and having to say a potentially last goodbye to his son, Dr. Berk emphasizes the importance of a leader to stay calm and logical even in a moment of crisis. By communicating with the kidnaper with calm and talking about back pains and listening to his life stories, Dr. Berk potentially saved his own life; by telling his son a benevolent and convincing lie, Dr. Berk protected his family from imminent danger. This experience not only reminded him to appreciate life and cherish time with loved ones, but also the responsibility of a leader to share the emotional burdens, such as grief, anxiety, and fear of their friends, colleagues, and families, to guide them through tough times.Utilizing the lessons the incident taught him, Dr. Berk strives to nurture the next generations of physicians as better professionals and better people. He wants to teach the right professional ethics to students, but also make sure that they are not mistreated in the healthcare system.More About Our Guest:Appointed Dean of the School of Medicine and Executive Vice President in 2006 and Provost at Texas Tech University Health Sciences Center in 2010, Dr. Steven Lee Berk M.D graduated from Boston University School of Medicine and completed his Internal Medicine residency and infectious disease fellowship at Boston City Hospital. He specializes in Internal medicine and infectious disease. In 1979, Dr. Berk moved to Johnson City in Tennessee in 1979. He joined the newly formed medical school at East Tennessee State University, where he became the Chief of Infectious Disease in 1982 and professor of Medicine in 1986. He later became the chairman of the Department of Medicine in 1988. In 1999, Dr. Berk joined the faculty of Texas Tech University Health Sciences Center, where he held the positions of Regional Dead for the Amarillo Campus, professor of Medicine, and Mirick-Myers Endowed Chair in Geriatric Medicine.He was appointed as Dean in 2006. He is the author or co-author of over 120 peer-reviewed publications and four textbooks. He is a Fellow of the American College of Physicians, the Infectious Disease Society of America, the American Geriatric Society, and the American College of Chest Physicians. He has served on the NIH Special Advisory Panel on the evaluation of vaccines against infections in the elderly, on the editorial board of the Journal of the American Geriatric Society, and as a reviewer for most Internal Medicine and Infectious Disease journals. He serves on the Board of Directors Nominating Committee for the Association of American Medical Colleges and is chair of the AAMC community-based deans subcommittee. Click this link to see the full description!---------------------------------------------------------------------------------------------https://www.ttupress.org/9780896726932/anatomy-of-a-kidnapping/https://www.linkedin.com/in/steven-berk-758192a/https://www.ttuhsc.edu/

The State of COVID-19 with Dr. Bertha Ayi.Dr. Bertha Serwa Ayi, MD, FACP, FIDSA, MBA Shares Important Information on COVID-19.About GuestDr. Bertha Serwa Ayi, MD, FACP, FIDSA, MBA is a Board Certified Infectious disease specialist.She is a Clinical Assistant Professor of Medicine at the Kansas Health Science Center and University of North Dakota, USA, an adjunct lecturer at the University of Development Studies in Tamale, Ghana and the University of Health and Allied Sciences in Ho, Ghana.Dr. Ayi is the President elect of the Ghana Physicians and Surgeons Foundation of North America (GPSF) and a graduate of the University Of Ghana Medical School (UGMS Class of 1996) where she graduated with honors and received the Alcon/Paracelsus Award in Ophthalmology.She completed her Internal Medicine Residency training at Good Samaritan Hospital Inc., an affiliate of John Hopkins University School of Medicine in Baltimore Maryland in 2002.In 2004, she completed fellowship training in Infectious Diseases at a combined training program at Creighton University Medical Center, University of Medical Center and the Veterans Administration Hospital in Omaha, Nebraska.Additionally, Dr. Ayi completed a Master's in Business Administration with a focus on Health Services Administration at the University of South Dakota, graduating in 2013.She is a Board Certified Infectious Disease Specialist and a Fellow of the American College of Physicians (FACP) and the Infectious Disease Society of America (FIDSA).Dr. Ayi practices as an infectious disease consultant in Fargo, North Dakota.A well-loved speaker, she is an astute author with two published books. She has also written several articles, contributed to book chapters, numerous medical journals and internet publications.In 2015 she won the Women of Excellence award in the category of Women Striving to Improve the Quality of Life, under the auspices of Women Aware, a nonprofit organization.Dr. Ayi is passionate about global health, malaria eradication and efforts at poverty reduction.Humanity Chats - a conversation about everyday issues that impact humans. Join us. Together, we can go far. Thank you for listening. Share with a friend. We are humans. From all around the world. One kind only. And that is humankind. Your friend, Marjy Marj

Brian O'Doherty, President of the Irish Primary Principals Network, Terence Reynolds, Prinicipal of Schoil Naomh Bríd, Ballyconnell, Cavan, Yvonne Williams , GP in Shannon Medical Centre, Travel Plans, Sam McConkey, President of Infectious Disease Society of Ireland, David Coleman child psychologist

Dr. Thomas File, who is an Infectious Disease Specialist at Summa Health in Akron, and the former President of the Infectious Disease Society of America, explains why getting young children, ages 5-11 vaccinated against COVID-19 is an important step forward in reducing hospitalizations and deaths for both children and adults. In addition, he talked to us about how the MRNA technology that is at the heart of the Pfizer and Moderna vaccines works, and why it can help us fight a number of other diseases as well.

Dr. Paul A. Offit, MD, (https://www.paul-offit.com/) is an internationally recognized expert in the fields of virology and immunology, Co-Inventor of a landmark vaccine for the prevention of Rotavirus gastroenteritis, and holds multiple titles including - Director of the Vaccine Education Center at Children's Hospital Of Philadelphia (CHOP), Maurice R. Hilleman Chair of Vaccinology and Professor of Pediatrics, Perelmann School of Medicine, University of Pennsylvania, and Adjunct Associate Professor, The Wistar Institute of Anatomy and Biology. Dr. Offit was a member of the Advisory Committee on Immunization Practices to the Centers for Disease Control and Prevention, a founding advisory board member of the Autism Science Foundation and the Foundation for Vaccine Research, a member of the Institute of Medicine, and co-editor of the foremost vaccine text, Vaccines. Dr. Offit is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, a Research Career Development Award from the National Institutes of Health, and the Sabin Vaccine Institute Gold Medal. Dr. Offit has published more than 150 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of a landmark rotavirus vaccine recommended for universal use in infants by the CDC. For this achievement, Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases, and was honored by Bill and Melinda Gates during the launch of their Foundation's Living Proof Project for global health. In addition, he has received numerous other awards and honors for his groundbreaking work. Dr. Offit is also an author of many books including, but not limited to: Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases, Overkill: When Modern Medicine Goes Too Far, The Cutter Incident: How America's First Polio Vaccine Led to the Growing Vaccine Crisis, Breaking the Antibiotic Habit, Do You Believe in Magic, and his most recent, You Bet Your Life: From Blood Transfusions to Mass Vaccination, the Long and Risky History of Medical Innovation.

What is COVID 19 how does it spread https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus How do race and ethnicity differ in regards to covid? https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html How many variants are there and how do we track them? https://www.gisaid.org/hcov19-variants/ How do I tell how infections are going in my local community or even globally? https://covid19.healthdata.org/global https://coronavirus.jhu.edu/map.html https://www.nytimes.com/interactive/2021/us/covid-cases.html History of vaccines: https://www.historyofvaccines.org/timeline/all How vaccines are developed and monitored for safety? https://www.cdc.gov/vaccinesafety/ensuringsafety/history/index.html What is the FDA? https://www.fda.gov/drugs What is the NIH and NIAID? https://www.niaid.nih.gov/research/vaccines What the Infectious Disease Society of America Says about covid? https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5475249/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/thehealthflo/message

Episode 69: Asymptomatic Bacteriuria. When do you screen for and treat asymptomatic bacteriuria? Find out what the IDSA recommends during this episode. PARTNER studies demonstrated that HIV transmission is minimal with condom-less sex if viral load is undetectable.Introduction: Urine.  Urine is a straw-colored, pale yellow, or colorless liquid, which is by-product of metabolism. It is normally sterile when excreted under normal conditions, but it can also have bacteria even in the absence of infection. When you have bacteriuria with no symptoms, it is called asymptomatic bacteriuria or ASB. Today you will hear Dr Covenas, Dr Civelli and Dr Lundquist discussing when to screen and treat asymptomatic bacteriuria.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. [Music continues and fades…]_____________________________Asymptomatic bacteriuria (update by the IDSA)Written by Hector Arreaza, MD. Participation by Cecilia Covenas, MD; Valeri Civelli, MD; and Ariana Lundquist, MD.Case: 19-year-old female who came to clinic to review lab results with you. She is coming from another clinic and brings her results on paper. Routine labs were done 1 week ago. Her complete blood count is normal, TSH (thyroid stimulating hormone) is normal, hemoglobin A1C of 5.3, and a urine culture showing >100,000 CFU of E. coli. Patient denies dysuria, polyuria, or any urinary symptoms. She has a negative pregnancy test in clinic today. What are you going to do with this significant bacteriuria?This is an Asymptomatic Bacteriuria (ASB). The first question you may ask is “why did she get a urine culture in the first place?” The Infectious Disease Society of America (IDSA) published in its journal “Clinical Infectious Disease” an update in the management of ASB. It is a 28-page long document with answers to 14 questions regarding ASB screening and management in different patient populations.Recommended ASB screening and treatment: IDSA concluded that the only two groups of patients who benefit from screening and treatment of asymptomatic bacteriuria are: Pregnant women and patients who undergo traumatic urologic interventions that result in mucosal bleeding.Pregnant women: Recommend one urine culture at one of the initial visits early in pregnancy. There is insufficient evidence to recommend for or against repeat screening during the pregnancy for a woman with an initial negative screening culture or following treatment of an initial episode of ASB. Treatment: IDSA suggests 4–7 days of antimicrobial treatment rather than a shorter duration, the optimal duration of treatment will vary depending on the antimicrobial given; the shortest effective course should be used. Patients who will undergo endoscopic urologic procedures associated with mucosal trauma: Screening for ASB and treating prior to surgery is RECOMMENDED. The goal is to avoid serious post-operative complication of sepsis. IDSA suggests a urine culture prior to the procedure and targeted antimicrobial therapy prescribed rather than empiric therapy. If bacteriuria is detected, a short course (1 or 2 doses) rather than more prolonged antimicrobial therapy is recommended, and antibiotic should be initiated 30–60 minutes before the procedure.Against ASB screening and treatment: IDSA suggests no screening for or treating ASB in these patients:Pediatric patientsHealthy nonpregnant womenCommunity-dwelling persons who are functionally impairedOlder persons residing in long-term care facilitiesPatients with diabetesPatients who had a renal transplant over 1 month ago (insufficient evidence for less than 1 month ago)Patients with nonrenal solid organ transplantIndividuals with impaired voiding following spinal cord injury (consider atypical symptoms of UTI when deciding treatment vs nontreatment of bacteriuria in these patients)Short-term indwelling urethral catheter (30 days)Patients undergoing elective nonurologic surgeryPatients planning to undergo surgery for an artificial urine sphincter or penile prosthesis implantation (these patients should receive standard preop antibiotics before surgery)Patients living with implanted urologic devicesInsufficient evidence to recommend for or against ASB screening and treatment: Evidence is insufficient to recommend ASB screening and treatment in patients with high-risk neutropenia (absolute neutrophil count 7 days duration after chemotherapy). These patients should be treated with prophylactic antibiotics and start antibiotics promptly in there is fever. For low-risk neutropenic patients (neutrophils >100,

In this episode of M.ED: Medical Education for the Practicing Clinician, I had the unique opportunity to interview Dr. Andy Pavia. Dr. Pavia is a nationally known infectious disease expert and professor of pediatric infectious disease at the University of Utah. He has sat on national advisory committees for the CDC and Infectious Disease Society of America and has testified to Congress on public health threat preparedness. He has published more than 250 scholarly articles, textbook chapters, reviews, and scientific abstracts. He has known Dr. Fauci for thirty years. In this episode, we discuss COVID 19 vaccine hesitancy. We also discuss evidence-based ways that clinicians can address vaccine hesitancy that can help increase the number of people that will take the vaccine. On our website, you will find links to articles related to COVID vaccine hesitancy that can give you a more in-depth look at this issue. As always, free CME credit is available on the website as well. Please enjoy this stimulating and timely conversation with Dr. Pavia. You can visit the website at: https://medicine.utah.edu/students/programs/md/curriculum/ruute/preceptor/cme-podcast.php

Prof. Karina Butler, Chair of the National Immunisation Advisory Committee and President of the Infectious Disease Society as Ireland is in line to receive an additional 3.3 m doses of the Pfizer/BioNTech vaccine after the EU extended its contract with the pharmaceutical company.

Prof. Karina Butler, Chair of the National Immunisation Advisory Committee and President of the Infectious Disease Society as Ireland is in line to receive an additional 3.3 m doses of the Pfizer/BioNTech vaccine after the EU extended its contract with the pharmaceutical company.

Clostridioides difficile is an important cause of morbidity and mortality in the United States with over 500,000 infections annually. The Infectious Disease Society of America released a clinical quality measure focused on treatment of c diff in March 2020. A review of the diagnosis and treatment will help providers improve quality. This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today! The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections.  See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Clostridioides difficile is an important cause of morbidity and mortality in the United States with over 500,000 infections annually. The Infectious Disease Society of America released a clinical quality measure focused on treatment of c diff in March 2020. A review of the diagnosis and treatment will help providers improve quality. This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today! The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections.  See omnystudio.com/listener for privacy information.

Clostridioides difficile is an important cause of morbidity and mortality in the United States with over 500,000 infections annually. The Infectious Disease Society of America released a clinical quality measure focused on treatment of c diff in March 2020. A review of the diagnosis and treatment will help providers improve quality.This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today!The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections. See omnystudio.com/listener for privacy information.

Clostridioides difficile is an important cause of morbidity and mortality in the United States with over 500,000 infections annually. The Infectious Disease Society of America released a clinical quality measure focused on treatment of c diff in March 2020. A review of the diagnosis and treatment will help providers improve quality. This episode is accredited for CPE. Subscribe at CEimpact (https://www.ceimpact.com/pharmacist) and claim your CE today! The CE for this episode is supported by an educational grant from Xellia Pharmaceuticals, a specialty pharmaceutical company focused on providing important anti-infective treatments against serious and often life-threatening infections.  See omnystudio.com/listener for privacy information.

Dr. Mahmoud Ghannoum, aka Dr. Microbiome, is the Co-Founder and Chief Scientific Officer of BiohmHealth in Cleveland Ohio. He received an MSc in Medicinal Chemistry and his PhD in Microbial Physiology from the University of Technology in Loughborough, England, and an MBA from the Weatherhead School of Management at Case Western Reserve University, Cleveland, OH. He's a tenured Professor and Director of the Integrated Microbiome Core and Center for Medical Mycology, and, Case Western Reserve University and University Hospitals Cleveland Medical Center. He has published over 350 peer-reviewed publication and 6 scientific books Dr. Ghannoum established a multidisciplinary Center of Excellence that combines basic and translational research that spans the test tube to the bedside capabilities. He pioneered studies on the fungal communities residing in and on our body and coined the term ‘Mycobiome”. He was awarded the Rhoda Benham Award from the MMSA, and the Freedom to Discover Award from Bristol-Myers Squibb for his outstanding and meritorious contributions to the fields of medical mycology and microbial biofilms. He's a fellow of the Infectious Disease Society of America (IDSA), past President of the Medical Mycological Society of the Americas (MMSA). Fellow of the American Academy of Microbiology, and the European Society of Clinical Microbiology and Infectious Diseases (FESCMID). Overall, he is an entrepreneur-scientist who has launched a number of companies focused on the treatment of biofilm infections, as well as microbial dysbiosis.

Jatin Vyas, MD, PhD, is an Associate Professor of Medicine and the Program Director of the Massachusetts General Hospital's Internal Medicine Residency Program at Harvard Medical School, where he supervises over 200 interns and residents. Dr. Vyas received his PhD in immunology, working in the lab of Dr. Robert Rich at Baylor College of Medicine. After completing his MD at Baylor, he joined as a resident in internal medicine at Mass General, where he stayed on to pursue a fellowship in infectious diseases. An NIH funded investigator with an interest in basic sciences, Dr. Vyas is internationally recognized for his work in fungal immunology, investigating the body's immune responses to fungal pathogens. He is passionate about mentoring physician scientists and has advocated for the interests of physician scientists and training at the national level. Dr. Vyas has been selected as Fellow in the Infectious Disease Society of America and has been elected to the American Society for Clinical Investigation. It's not about winning or losing: It's about stepping up to bat. Today, Dr. Jatin Vyas shares fascinating—and moving—stories about his career in medicine. He explains why as physicians, going up to bat means putting ourselves out there to mentors. In order to learn from mentors, to hear their stories, and to understand the challenges they faced throughout their career—we must ask them. And when we make these connections and build relationships, we're almost certain to discover two things: That the path to success is never linear, and that prospective mentors we admire are much more similar to us as trainees than we think. Pearls of Wisdom: 1. Our mentors have faced similar challenges as us, but we won't know unless we ask. When we ask mentors about their personal stories, their challenges, and their own goals, we'll learn how non-linear the path to success really is. 2. It's not about winning or losing, it's about going up to bat. Even if we don't hit every ball, it's the fact we're up at bat in the first place that counts. 3. Turn to others—a chorus of voices—to help guide you along your path. Having a multitude of different people and perspectives is the most efficient way to get an answer, solve a problem, or make a decision. 4. Medicine is an infinite game. Burnout and disengagement happen when we view our role as a finite game.

Josephine Thinwa is a physician scientist at UT Southwestern in Dallas in the field of infectious diseases. She completed her MD/PhD degree in 2015 at UT Health San Antonio and joined UT Southwestern for Internal Medicine residency and Infectious Diseases fellowship as part of the Physician Scientist Training Program. She completed her residency and then Infectious Diseases fellowship in July 2019. During her infectious disease training, she became very interested in treating HIV/AIDS patients who are prone to severe viral brain infections. To this end, she is studying in the lab how our bodies fight viruses that infect the brain, hoping to develop new treatments. She has several publications in both clinical and scientific journals and has presented her research at numerous regional and national meetings where she received recognition for best poster awards. In 2018, she was featured on the main webpage of the Infectious Disease Society of America website as a member spotlight for her accomplishments thus far. Her goal is to have her own lab within the next few years and continue doing research that impacts patients while maintaining her clinical practice. By listening to this conversation with Josephine, you’ll learn about: - Being a black woman and a “double doctor” - Women and surnames - Redirecting presentations from hostile audience members - Addressing insecurities when communicating

The threat of COVID-19 is ongoing, anywhere from small towns in the middle of America all the way to the White House. Dr. Thomas FIle is with Summa Health, and he also heads up the Infectious Disease Society, and he spoke in depth of these threats on the Ray Horner Morning Show during his bi-monthly visit. Though some across the globe have speculated this being the second wave of this coronavirus, Dr. File maintains this is still the first wave, a continuation of what the United States experienced in the first half of 2020. He also touched on the possibility and timeline of an effective vaccine. The fall may bring football and the changing colors of the trees, it also brings respiratory illness, and Dr. File stresses the listeners to get their flu shots and continue to mask up and socially distance.

As each day passes, more information is being learning about COVID-19, and that goes for the common novice to infectious disease experts. One of those disease experts is Summa Health’s Dr. Thomas File, who also heads up the Infectious Disease Society. Dr. File spoke on the Ray Horner Morning Show about what he and his medical colleagues have learned in these last six months about this novel coronavirus, from the transmission in asymptomatic patients to studying the after effects those who have recovered are experiencing. Other aspects discussed by Dr. File were on masks and antibodies, the ethnic disparity in cases and mortalities, and how close the United States is to finding a vaccine.

This week on Alive and Kicking Clare McKenna talks to Mark Walton of Voya about the health benefits of Seaweed. She chats to policy advisor Andrew Wear about his book 'Solved|! How Other Countries Have Cracked the World's Biggest Problems and We Can Too'. Plus with the kids returning to school soon Clare chats with President of the Infectious Disease Society of Ireland Prof Karina Butler to find out if classroom clusters really are inevitable.

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Margaret Kimberley, an activist, columnist, and author, whose latest book is called “Prejudential: Black America and the Presidents,” and KJ Noh, a San Francisco activist and scholar on the geopolitics of Asia, and a frequent contributor to Counterpunch and Dissident Voice.Presumptive Democratic presidential nominee Joe Biden yesterday chose California Senator Kamala Harris to be his vice presidential running mate. Harris is the first African-American and Indian-American woman to appear on a major-party ticket. But not everybody is celebrating. Harris is a former prosecutor and state Attorney General, and she is responsible for imprisoning thousands of people under California’s drug laws. She has a conservative voting record on foreign affairs and issues of war and peace. And leaders of Wall Street banks are telling their clients that there is now no cause to worry about a Biden win in November. Covid-19 continues to spread through recently reopened schools, especially in the southern United States. Many school districts there reopened two weeks ago, only to see thousands of new infections and then to close again. Meanwhile, cruise ship employees say that after passengers departed, they were stranded on the ships for months. Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee, joins the show. Large-scale protests continue in Bolivia against the decision by the coup-installed government of the country to once again postpone elections. As strikes and roadblocks bring the country to a standstill, right-wing paramilitary groups are being mobilized by pro-coup forces to violently repress demonstrators. Brian and John speak with Arnold August, a journalist, the author of three books on Cuba, Latin America, and US foreign policy, and a Fellow at the Canadian Foreign Policy Institute. Wednesday’s weekly series, In the News, is where the hosts look at the most important ongoing developments of the week and put them into perspective. Sputnik news analysts Nicole Roussell and Walter Smolarek join the show.Wednesday’s regular segment, Beyond Nuclear, is about nuclear issues, including weapons, energy, waste, and the future of nuclear technology in the United States. Kevin Kamps, the Radioactive Waste Watchdog at the organization Beyond Nuclear, and Sputnik news analyst and producer Nicole Roussell, join the show.

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Mara Verheyden Hilliard, the executive director of the Partnership for Civil Justice Fund.A viral video is making the rounds on social media and in the mainstream news that shows a Navy veteran and graduate of the US Naval Academy being brutalized by a federal officer in Portland, Oregon. The man is standing peacefully, when he is attacked by a federal officer in fatigues, who strikes him with a club multiple times, breaking his hand, while another officer sprays him in the face with pepper spray. That’s the situation in Portland, where these federal officers--with no name tags and no identifying features--have taken to the streets. They are even kidnapping protestors and taking them away in unmarked vans. The 2020 presidential campaign seems to get crazier and crazier. President Donald Trump gave an interview over the weekend to Fox News’s Chris Wallace that became combative and called into question whether Trump can maintain his base as we get closer to the election. Meanwhile the latest national polls show Joe Biden leading Trump by 15 percentage points. Joe Lauria, the editor-in-chief of Consortium News, founded by the late Robert Parry, and the author of the book "How I Lost, By Hillary Clinton," joins the show. The coronavirus continues to spread at an increasingly rapid rate, especially across the southern United States. Nationally, Covid-19 is infecting 20 people per 100,000 residents. But the infection rate is far higher in many states, with Florida at 55 people per 100,000 residents, Arizona at 44, Louisiana at 41, and Nevada at 39. And deaths stand at nearly 141,000. Meanwhile, the European Union announced that it would not allow Americans to travel there at least until July 31. Brian and John speak with Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee. Monday’s segment “Education for Liberation with Bill Ayers” is where Bill helps us look at the state of education across the country. What’s happening in our schools, colleges, and universities, and what impact does it have on the world around us? Bill Ayers, an activist, educator and the author of the book “Demand the Impossible: A Radical Manifesto,” joins Brian and John. In this segment, The Week Ahead, the hosts take a look at the most newsworthy stories of the coming week and what it means for the country and the world, including Trump’s efforts to minimize his administration’s mishandling of the Coronavirus crisis, the state of the 2020 presidential election, the kidnapping of protesters by unidentified federal agents in Portland, and more. Sputnik News analysts and producers of this show Nicole Roussell and Walter Smolarek join the show.Monday’s regular segment Technology Rules is a weekly guide on how monopoly corporations and the national surveillance state are threatening cherished freedoms, civil rights and civil liberties. Web developer and technologist Chris Garaffa and software engineer and technology and security analyst Patricia Gorky join the show.

About John Cascone: Dr. Cascone, is a Board Certified Internal Medicine and Infectious Disease Physician. His internal medicine residency was done at the University of Kansas and infectious disease follow up at the University of Missouri, Columbia. He is the Medical Director of nursing homes in southwest Missouri. His medical practice includes the care of residents in long term care facilities, infectious disease consultations and telemedicine and infectious disease services to rural facilities. He has a special interest in the diagnosis and treatment of sepsis, C diff, colitis, staphylococcus aureus, antimicrobial stewardship, and pressure ulcers. He lives in Joplin, Missouri with his family. In this episode, Steve and John discuss:1. What is C. diff?C. diff refers to the organism that formerly was identified as Clostridium difficile, but has now been changed to Clostridioides difficile. So the organism and as we'll refer to it as C. diff, is essentially an organism that resides in our bowel and it is a spore forming organism, meaning within the gut exists as a bacteria that produces toxin that leads to the diarrhea that we'll talk about in a bit. Outside of the gut, it converts to a spore. That spore is very hardy, difficult to kill and difficult to get rid of, which leads to the significant risk of transmission that occurs.2. What is a spore? A spore is essentially a non replicating form of an organism, meaning it is a hibernation type of the existence. So, the organism is no longer replicating in the way antibiotics work in killing bacteria. Typically bacteria has to be dividing and increasing in number. So a spore is a vegetative state that is highly resistant and impermeable to antibiotics.3. Is it dangerous?It is dangerous and very contagious.4. What is a bacterial infection as opposed to a viral infection or another type of infection?An infection refers to the invasion of an organism in a normally sterile site that leads to inflammation and disease. In this case, we're talking about the bowel. So it doesn't necessarily have to be a sterile site, but it has an organism that has led to some degree of inflammation and subsequent infection, whether it be a bacterial etiology or a viral etiology. The end result is inflammation of tissues, disruption of tissues and symptoms.5. Is the affected organism the colon?No, the effective organ is the colon. I said originally a sterile site. That is not a sterile site, the colon, but the organism leads to inflammation within that site.6. So the spore or the seed is what causes the inflammation in the colon?The way that works is C. diff is outside of the bowel. It is a replicating organism, it's a bacteria. In the way C. diff causes colitis with diarrhea, it's not the bug itself it is the toxin that is produced from the C. difficile. It produces two toxins toxin A, toxin B and in certain cases can produce a third toxin called a binary toxin. Those toxins are poisonous to the lining of the gut  and they cause the gut to get inflamed, to leak water and leads to diarrhea and all types of other manifestations of the illness.7. Is diarrhea the main symptom of C. diff?Yes, so they have C. diff colitis and C. diff infection colitis. There has to be an infection of the colon to have had diarrhea. If there's no diarrhea, then you do not have C. diff infection. You may still have C. diff in the bowel and up to 20% of people who are hospitalized, in 50% of people who reside in long term care facilities if you check their stool, will have C. diff present. But unless the patient has diarrhea, there's no evidence of an infection. So you have to have the diarrhea to have the infection. A good rule of thumb for diarrhea is that the stool can no longer hold up a popsicle stick. So if it can't hold up the stick, then that is considered diarrhea by definition.8. If there's no diarrhea, but there is C. diff in the bowel then it's kind of laying dormant or it's there and can lead to infection?It's there, it can lead to transmission, but if there's no indication you don't treat that. You shouldn't be testing stool for C. diff in the first place. You should only perform C. diff studies or C. diff laboratory studies on stool in the presence of diarrhea.9. In your opinion what exactly is the cause of C. diff?The primary cause of C. diff is the use of antibiotics and antibiotics used to treat other infections in any antibiotic administration, even one dose can cause C. diff. That's an unfortunate event, but that’s when used inappropriately. If antibiotics are used to treat a urinary tract infection, and are used inappropriately, then it increases the risk of C. diff. That's what has caused this rise of C. difficile colitis or C. difficile infections in this country over the last 10 to 15 years. The appropriate use of antibiotics requires that a BB gun be used as opposed to a shotgun. So, the most specific antibiotic to kill that infection, say a urinary tract infection to treat that for an appropriate duration. For instance, a urinary tract infection should be treated for three days. So, if antibiotics are used, or they are too broad a spectrum and are used for a long period of time, longer than what is indicated, it increases one's risk of getting C. diff colitis.10. Isn't there a recognized protocol for how many days somebody should be taking antibiotics for urinary tract infection? Why would they be treated for more than the recommended protocol?There are recommended protocols. The whole shift of infectious disease has been less antibiotic or more specific antibiotic for a shorter duration, we're finding that, for instance, pneumonia, five days of treatment is adequate, no longer 10 to 14 days. There are medical guidelines, the Infectious Disease Society of America guidelines tell us how to treat infections, what antibiotics to use and for the duration. There's no indication and there's no reason to use anything longer than three to five days at the upper end of it for a simple urinary tract infection.11. The aging well article that I referred to earlier also mentions a weakened immune system, long institutional stays and GI surgery as other causes of C. diff. So if you don't have diarrhea, but you had a bad result from GI surgery, you stay in a nursing home and have been there a long time and your immune system is weakened, is that something that without diarrhea would not make the doctors even consider that it’s C. diff?No they wouldn't treat you for C. diff without diarrhea. They shouldn't really even be finding C. diff because there's no reason to do stool studies. Certainly, C. diff colitis is diarrhea but certainly those risk factors that you've mentioned, can lead to C. diff colitis. Not only the advanced age, but in antibiotic use, hospitalization, chemotherapy, inflammation and inflammatory bowel disease are all risk factors.12. Most people in those situations are on antibiotics so all of it together creates the perfect storm, Correct?Correct. That's why you want to be vigilant in using antibiotics judiciously, not over prescribing them and keeping patients out of harm's way when they don't need to be there.13. How dangerous is C. diff? What can be expected in a mild case of C. diff, as opposed to a severe case of C. diff?The mortality of C. diff has a lot to do with the underlying condition of the patient. As we get older, we typically have more comorbid illnesses and we're on other medications. We have other disease processes that are being treated, and then increases our risk for a bad outcome. C. diff can have a mortality of upwards 16 to 20% and, of course, if you're sick with other illnesses, that mortality can go up even higher. The way C. diff presents as we talked about, it's diarrhea but could also be worsening symptoms other than diarrhea, and that is abdominal distension, fever, nausea, vomiting, abdominal pain, or cramping. If C. diff colitis gets bad enough, it can actually shut the entire gut down, and patients no longer have bowel movements. So it can lead to constipation on the far end of the spectrum.14. What can happen if not adequately dealt with what can be the consequences from that point on?First and foremost, patients can become dehydrated from the diarrhea. In volume, salt water that's passed to the stool. So dehydration, sepsis can certainly occur as a result of the inflammation in the colon, then multi organ failure and as mentioned in 15 to 20% of patients death.15. Are seniors and the elderly the highest at risk part of the American population or world population? Why? They probably are the population that is at highest risk for acquiring C. diff, and they are the population that is at highest risk for bad outcome. That is because the older we get, we typically have multiple other medical problems. That impairs our ability to fight infection, we're typically on more medications that impair our ability to fight infection and our overall ability to overcome is reduced as we get older, we become more vulnerable. The health care provider needs to make sure that patients are appropriately diagnosed and treated and not over prescribed antibiotics to reduce the incidence of C. diff in our elderly patients.16. What is it about senior care facilities or nursing homes that increase the risk of C. diff?In senior care facilities, one increases the risk of contracting C. diff. Those facilities are where antibiotics are prescribed to other patients in the facility. So if there's antibiotics prescribed in the facility where you live it impacts the risk of other patients getting C. diff, and then you contract it from somebody else. That's the primary cause, just being close to others who are getting antibiotics and potentially could get C. diff and pass it to you.17. Do you see C. diff in little kids or schools or only in the senior and elderly population because of the weakened immune system and all the aging? It's the weakened immune system in the population more at risk for getting C. diff and for having a bad outcome. Interesting about kids. The reason you don't see C. diff in infants and nurseries, is because they don't have the receptors for the toxin to bind to and cause inflammation. So they still have C. d-ff in fact, some people think they're reservoirs of C. diff, but they don't get C. diff colitis because the toxin is ineffective in them.18. They're probably not being over prescribed antibiotics like our senior and elderly population are?Exactly.  If you look at a gut it is populated with millions and billions of organisms. Bacterias that, for the most part, help us have a nice healthy bowel and the bacteria also keep the bad bacteria at bay. C. diff still is one of those bad bacteria. When somebody is prescribed antibiotics for a urinary tract infection or pneumonia, that antibiotic not only kills the bacteria causing the urinary tract infection, pneumonia, but it also kills all the good bacteria in the gut. When the good bacteria are killed the bad bacteria, like C. diff, are allowed to start repopulating and then cause colitis and diarrhea.19. Would you advise our listeners to begin taking probiotics as a way to increase the good bacteria in the gut?The jury really is out on probiotics. I don't think there's anything wrong with doing it. I'm just not sure it's going to provide you with any benefit. Certainly, keeping the gut populated with good bacteria will be a benefit. The primary thing our elderly patient should do is when their doctor prescribes them an antibiotic, they should inquire and make sure that the physician is giving them the right antibiotic for the right duration. Shorter is better than longer when it comes to duration.20. When our listeners are getting the information about what antibiotic they were recommended or prescribed and how long it was prescribed for, how do they know whether it's over prescription or not?Starting the dialogue with your provider should force him to think about his decision and the antibiotic that he's using and for what duration. Some antibiotics that are really notorious are Levofloxacin, Levaquin, or Ciprofloxacin and these high powered antibiotics, really do a number if you will, on the gut and on the normal flora, the good bacteria in the gut, and cause  severe bouts of C. diff colitis. It's important to always be inquisitive, to always ask your providers and take nothing for granted when they prescribe antibiotics. I think they're probably the most overused, inappropriately used of all the drug classes out there.21. What are nursing homes and senior care facilities doing to address the problem of overuse of antibiotics?There's been a real push and rightly so, toward antimicrobial stewardship in long term care facilities and hospitals. Microbial stewardship essentially is somebody such as an infectious disease physician, overseeing the use of antibiotics in a facility and making sure the antibiotics are used for an appropriate diagnosis and that the antibiotic prescribed is a narrow spectrum as opposed to a broad spectrum antibiotic and it is prescribed for the appropriate duration. That push with regards to the use of antibiotics appropriately, really has done wonders to reduce the incidence of C. diff. The other things nursing homes do and should do is good hand hygiene. Because the alcohol based solution that you rub on your hands does not kill C. diff. You need to wash your hands with soap and water for two minutes and in fact, the soap and water does not kill the C. diff. What it does is some mechanical action that gets the spores off of the hands in patients who have it. If you're in a long term care facility, and your roommate has C. diff, you should be isolated from your roommate because there's a risk of them giving it to you.22. Wouldn't disinfection of hospital rooms on a consistent basis, and healthcare providers wearing gowns and gloves also be part of the protocol?Important preventive measures that are used in contact isolation when a patient has C. diff requires a gown, gloves, a throw away stethoscope so that the spores don't get on your stethoscope and you pass to another patient. In addition room disinfecting is an important measure. The spores as I mentioned are very hardy and even the best disinfection of a room is not always adequate. In fact, studies have shown that if a patient in the room before you had C. diff, you are more likely to acquire C. diff during your stay in that room.23. If somebody is demonstrating symptoms of C. diff, is there a standard test that they should be given or what is the test that is being utilized by the medical community to see if they have C diff? How reliable is it?We use a standard test that's called a PCR or a NAAT test, that looks for the toxin in the gut. It's very reliable and if it's present, you have it. If it's not present, you don't have it.24. Do they just take a stool sample and put it under the microscope?They take a stool sample that has to be a diarrheal stool sample. It has to be diarrhea, and then they run a chemical test on it, which looks for the production of toxin in the diarrheal stool.25. What would be the gold star treatment for somebody with C. diff?Antibiotics, and the antibiotics we use our oral antibiotics, vancomycin, or fidaxomicin is the first choice. It is orally given by mouth and what it does is it stays within the gut and it does not get absorbed into the systemic system. It stays within the gut and it is specific for killing the C. difficile bacteria within the bowel. That treatment is 10 to 14 days. Sometimes you can be prescribed vancomycin for a longer period of time, if you're on other antibiotics to treat another infection, sometimes they have to overlap. But typically it's 10 to 14 days.26. Are fecal transplants one of the additional types of treatments for individuals who have severe C. diff, and the antibiotics aren't working?Yes, fecal transplants are actually a very effective treatment for C. diff colitis. Fecal transplants provide stool from a donor and that stool is populated with all the good bacteria that normally resides in our bile. That sample is then put into the gut of the patient who has C. diff colitis and when you do that, you repopulate all the normal bacteria. The way vancomycin works is to kill the C. difficile. The way a fecal transplant works is to repopulate the good bacteria to suppress the production of the bad bacteria, which in this case is C. diff.27. Fecal transplants sound a little radical, but how effective are they?It's very effective and oftentimes can be life saving.28. What is the risk level for the general American population to develop C. diff?1% of patients that are hospitalized, will get C. diff colitis. It's important to note that there is such a thing as community, associated C. diff colitis. These are patients who have not been hospitalized have not been on antibiotics and develop C. diff colitis. What I don't want our listeners to think is just because I haven't been in the hospital, just because I haven't gotten any recent antibiotics. There's no way I can have C. diff. It’s uncommon, but it's still possible and your doctor should check you for it.29. What would you say to our listeners if they are in a nursing home, or they have a loved one in a nursing home, or a senior care facility and they're starting to show symptoms of C. diff? What action steps would need to be taken?If an elderly patient is in a nursing home and begins to develop diarrhea, abdominal pain, fevers, nausea, vomiting, whether they've recently gotten antibiotics or not, they should notify the provider, the nurse in charge immediately and then the patient should be checked with not only a stool sample to make sure C. diff isn't present, but also with laboratory to make sure that kidneys are not getting affected from the diarrhea in terms of dehydration, and check the white blood cell count to make sure it's not elevated due to the severe colitis. It's not something they should wait on, they should notify the providers immediately."Practice good hand hygiene because the alcohol based solution that you rub on your hands does not kill C. diff. You need to wash your hands with soap and water for two minutes and in fact, the soap and water does not kill the C. diff it’s the mechanical action that gets the spores off of the hands. " —  John CasconeTo find out more about the National Injured Senior Law Center or to set up a free consultation go to https://www.injuredseniorhotline.com/ or call 855-622-6530 Related Links:https://www.todaysgeriatricmedicine.com/archive/012312p18.shtmlConnect with John Cascone: Email: jcascone77@gmail.comCONNECT WITH STEVE H. HEISLER:Website: www.injuredseniorhotline.comFacebook: https://www.facebook.com/attorneysteveheisler/LinkedIn: https://www.linkedin.com/company/the-law-offices-of-steven-h.-heisler/about/ Email: info@injuredseniorhotline.com  Show notes by Podcastologist: Kristen Braun Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it. 

The Infectious Disease Society of America just updated their treatment guidelines for COVID-19 to recommend dexamethasone and remdesivir for treating hospitalized patients with severe disease.

On today's episode of Loud & Clear, John Kiriakou is joined by Dr. Krutika Kuppalli, an infectious disease physician and vice-chair of the Infectious Disease Society of America’s Global Health Committee.

Many states that have reopened their economies from coronavirus shutdowns are seeing a dramatic surge in COVID-19 infections. Some have reinstated certain restrictions, and Texas has paused its reopening plan. Gov. Andy Beshear and state health officials say Kentucky remains in a plateau, but the commonwealth continues to record scores of new coronavirus cases daily, with many recent ones tied to out-of-state travel.  Health officials say numerous people have returned to Kentucky with COVID-19 after traveling to Myrtle Beach, South Carolina. Starting Monday, bars across Kentucky can reopen under certain conditions, people can congregate in groups of up to 50, and other activities will be permitted.  The state has also released its plan for the reopening of schools this fall, and Churchill Downs says the Kentucky Derby will be held — with spectators — on September 5. Today on In Conversation, we talk about the coronavirus pandemic in Kentucky and how a surge in cases would affect the state's reopening plan. Two guests join us for this segment: Mike Berry, Secretary of Kentucky Tourism, Arts, and Heritage Cabinet, and Dr. Krutika Kuppalli, Vice Chair off the Infectious Disease Society of America's Global Health Committee. Plus, this is Pride Month, but amid the coronavirus pandemic and the racial justice demonstrations around the world, the celebration is different this year.  We talk about it with Allen Hatchell, outgoing president of Kentuckiana Pride, and DJ Victoria Syimone Taylor. Listen to In Conversation live on 89.3 WFPL Friday morning at 11:00.  Donate to support this and future seasons of In Conversation.

On today's episode of Loud & Clear, John Kiriakou is joined by Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee. The House of Representatives today is voting on a landmark bill to make Washington, DC, a state. The bill won’t pass the US Senate, and President Trump has vowed to block it due to the additional anti-Trump representatives the measure would bring. Georgia Republican Rep. Jody Hice said of the vote “The District is not prepared to shoulder the burden of statehood. This would apply economically, fiscally as well as a host of other ways.” This is an extension of the long racist history of the federal government’s rule over the District of Columbia. Maurice Cook, the founder and executive director of Serve Your City and a co-founder and co-chair of March for Racial Justice, joins the show with Brian Becker. Russians have begun voting on a wide range of constitutional reforms that would rebalance the relative powers of different branches of the government. The vote is taking place over the course of a week as a measure to reduce overcrowding during the pandemic. What do the constitutional reforms tell us about the future of Russian politics? Brian speaks with Bryan Macdonald, a journalist who specializes in Eastern Europe and Russia. It’s Friday! So it’s time for the week’s worst and most misleading headlines. John speaks with Steve Patt, an independent journalist whose critiques of the mainstream media have been a feature of his site Left I on the News and on twitter @leftiblog.Friday is Loud & Clear’s weekly hour-long segment The Week in Review, about the week in politics, policy, and international affairs. Today they focus on the near-record-breaking surge of Coronavirus infections being detected across the country, protests against racism and the brutal police repression of those protests, the controversy over racist statues and monuments, the latest attack on the Affordable Care Act, and moreSputnik News analysts and producers Walter Smolarek and Nicole Roussell join Brian and John.

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Sputnik News analysts and producers Walter Smolarek and Nicole Roussell.Friday is Loud & Clear’s weekly hour-long segment The Week in Review, about the week in politics, policy, and international affairs. Today they focus on the ongoing protest movement sweeping the country, the victories against racist monuments and memorials, divisions between the White House and the military, and more. Confirmed cases of Covid-19 are skyrocketing in a dozen states, mostly in the Deep South and the Midwest as governors insist that their states reopen. In those 12 states, confirmed cases are up more than 50 percent over what they were two weeks ago. Only Utah’s governor announced that the state would delay its reopening to deal with the new cases. Four of those states--North Carolina, South Carolina, Florida, and Nevada--are now seeing a record number of new coronavirus cases. Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee, joins the show with John. Large-scale peaceful protests continued across the country this week, and there are plans for more over the weekend. Protesters in Seattle took control of a local police precinct and began handing out free food and water. And statues commemorating confederate leaders continue to be toppled. Meanwhile, President Trump announced yesterday that the Republican National Convention would be moved to Jacksonville after the governor of North Carolina would not allow delegates to attend without wearing masks. Even more controversially, the White House announced that the President’s first post-Covid-19 campaign rally would be held in Tulsa, Oklahoma, the site of the worst anti-black massacre in the country’s history. And that rally will be held on June 19th, also known as Juneteenth, the day on which the entrance of Union troops into the last bastion of slavery is commemorated. Brian speaks with Estevan Hernandez, an organizer with the ANSWER Coalition who has been in the streets helping to organize recent protests. Eleanor Goldfield has just completed a long-form documentary that is unlike anything that’s been done on the issue of fracking and the environment in West Virginia. Hard Road of Hope introduces you to the people of West Virginia and shows you the toll that more than a century of coal mining and fracking has taken on the land and the people of that beautiful state. The film was just selected by the Rome Independent Prisma Awards. Creative activist and journalist Eleanor Goldfield, host of the podcast Act Out!, which airs on Free Speech TV, whose work is at ArtKillingApathy.com, and who is the writer, director, and producer of Hard Road of Hope, joins the show with Brian. It’s Friday! So it’s time for the week’s worst and most misleading headlines. John speaks with Steve Patt, an independent journalist whose critiques of the mainstream media have been a feature of his site Left I on the News and on twitter @leftiblog, and Sputnik producer Nicole Roussell.

With the world turning its attention more to treatment solutions and even potential COVID-19 cures, Stony Brook University has been leading antibody screening, enrolling patients in a convalescent plasma trial and conducting more than 180 dedicated research projects across all disciplines … all with the aim of winning the long-term Coronavirus battle. Stony Brook University Interim President Michael Bernstein hosts this episode of Beyond the Expected podcast and is joined by three Stony Brook guests to talk about how our researchers have stepped up and responded, about the research they're doing, and about the latest thinking on what antibodies can and can't tell us about this disease. Guests: Dr. Elliot Bennett-Guerrero is Medical Director for Perioperative Quality and Patient Safety for Stony Brook Medicine. He's also Professor and Vice Chairman for Clinical Research in the Department of Anesthesiology in Stony Brook University's Renaissance School of Medicine. Dr. Bennett-Guerrero has been involved in research projects running the gamut from the safety and effectiveness of blood transfusion, to surgical site infection, postoperative morbidity and cancer recurrence. Most recently, he launched a clinical trial of donated, post-convalescent plasma from up to 500 COVID-19 patients and is also conducting antibody testing with 500 healthcare workers. Dr. Bettina Fries is Chief of the Division of Infectious Diseases at Stony Brook Medicine, and is nationally recognized as a physician-scientist in the field of microbiology. She is a Professor of Medicine, Microbiology and Immunology at the Renaissance School of Medicine. She is also an attending at the Northport Veterans Affairs Medical Center and a Fellow of the Infectious Disease Society as well as the American Academy of Microbiology. A primary focus of her research has been on the development of antibodies against multidrug-resistant bacteria and on Cryptococcus neoformans. During this pandemic, Dr. Fries has consulted on COVID-19 infected patients and chairs the clinical trial task force that reports to our Hospital Incident Command System. Dr. Richard Reeder is Vice President for Research and serves as Associate Vice President for Brookhaven National Laboratory Affairs, acting as Stony Brook's liaison to the nearby Department of Energy laboratory co-managed by Stony Brook University and Battelle Memorial Institute. He is also a member of the Brookhaven Science Associates Board of Directors and retains the position of Professor of Geochemistry in the Department of Geosciences, where he served as Chair for 2008-2013. Dr. Reeder's research interests have spanned several primarily environmental-based areas. Production Credits Guest Host: Michael Bernstein Executive Producer: Nicholas Scibetta Producer: Lauren Sheprow Art Director: Karen Leibowitz Assistant producer: Ellen Cooke Facebook Live and Social Media: Meryl Altuch, Emily Cappiello, Casey Borchick, Veronica Brown Production assistant: Joan Behan-Duncan YouTube Technician: Dennis Murray Vodcast Director: Jan Diskin-Zimmerman Engineer/Technical Director: Phil Altiere Production Manager/Editor: Tony Fabrizio Camera/Lighting Director: Jim Oderwald Camera: Brian DiLeo Original score: “Mutti Bug” provided by Professor Tom Manuel Special thanks to the School of Journalism for use of its podcast studio https://renaissance.stonybrookmedicine.edu/COVID_DonatePlasma

Dr. Ravi Kamepalli is our special interview guest on Episode 1645 of The Livin’ La Vida Low-Carb Show. “Healthcare is godly, but it is not God.” - Dr. Ravi Kamepalli Dr. Ravi K. Kamepalli is a Board certified Infectious Disease physician and an Epidemiologist. He certified wound specialist and Diplomate of American board of obesity medicine practicing at Regional Infectious Diseases and Infusion Center, Inc. Lima, Ohio since 2003. Dr.Kamepalli received his medical degree from Guntur Medical College, Guntur, AP, and India. He did his residency at Wyckoff Heights Medical center, Brooklyn, New York and Infectious Diseases fellowship at Saint Vincent Catholic Medical Center, New York. He has also been conferred Fellow of Infectious Disease Society of America (FIDSA) for achieving professional excellence in infectious diseases. He is a Clinical Assistant Professor in department of Internal Medicine, Infectious Disease, The University of Toledo College of Medicine and Life Sciences. He was the Past Medical director of hyperbaric clinic and chief of division of Infectious Diseases at St.Ritas Medical Center. He has a passion for all things infection and wound related, with a particular emphasis on Healthcare delivery, transition of Care and use of technology including telemedicine to break down barriers to healing. He has particular understanding and interest in population health as it helps to have greater impact. He has participated on multiple Expert Consensus Panels and has been a speaker at multiple national and international conferences. He is actively involved in clinical research in over 60 Clinical trials. His dream project ( http://www.nobadbugs.com/dream-project.html ) is to create a self-sustaining health care system in India and he understands that is only through the use of Population health methodologies and technologies like telemedicine. Listen in today as Jimmy talks with Dr. Kamepalli all about Covid-19 and his findings might just surprise you. Links mentioned in this episode: https://ir.library.louisville.edu/jri/vol4/iss1/7/ https://thisamericandoc.com/user/ravi-kamepalli/ http://nobadbugs.com

While we can’t be sure what’s in store for us with the future of COVID-19, we can try to learn from the past to tackle this situation in the smartest way possible. That means looking at previous infectious disease epidemics and understanding zoonotic diseases like this one, that are passed from animals to humans, and how they’re different from the other pandemic diseases we’ve been able to eradicate. I was excited to connect with Dr. Steven Gordon to dig into these topics deeper, today on The Doctor’s Farmacy. Dr. Gordon is the Chairman of the Department of Infectious Diseases at the Cleveland Clinic Foundation and Professor of Medicine at the Lerner College of Medicine at Case Western University. His clinical interests include infective endocarditis including cardiac electronic implantable device infections as well as opportunistic infections in immunocompromised patients. He is a Fellow in the American College of Internal Medicine and a Member of the Infectious Disease Society of America. Dr. Gordon is the person to talk to when it comes to gaining a better understanding of infectious diseases. He explains some of the unique characteristics of SARS-CoV-2 and how they will dictate the way we move forward with healthcare and as a society in the coming years. The good news is that Dr. Gordon has a positive outlook about our ability to cope with COVID-19. *For context, this episode was conducted on May 1, 2020Here are more of the details from our interview:Lessons learned from previous infectious disease epidemics (3:11)Unique characteristics of SARS-CoV-2 and how they will influence our ability to move forward as a society over the next few years (6:12)Evaluating infection rates, antibody testing, and mortality rates (9:39)Do we need widespread testing, and is it even possible? (12:02)Why are some locations affected more than others by coronavirus? (13:53)Treatments for COVID-19, what we’ve tried and what might be coming (18:44)Why a COVID-19 vaccine might not be the magic bullet we’ve been waiting for (22:51)Wearing masks and other culture change for effective COVID-19 prevention (31:18)Dr. Gordon’s coronavirus projections for the next two years (35:33)Can you get COVID-19 more than once? (38:28)How healthcare could improve if 5G and internet were a free utility for all (46:27) See acast.com/privacy for privacy and opt-out information.

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Sputnik News analysts and producers of this show Nicole Roussell and Walter Smolarek join the show.Friday is Loud & Clear’s weekly hour-long segment The Week in Review, about the week in politics, policy, and international affairs. Today they focus on the media’s bent against China even and especially in these serious times, Trump’s unrealistic and dangerous plan to reopen the country, and Bernie Sanders endorsing Joe Biden for president. President Trump has said repeatedly over the past several weeks that he wants to reopen the country--and the economy--sooner, rather than later. But medical experts say that’s not realistic, or safe. The President has even named a panel, that includes Jared Kushner and Ivanka Trump, to restart the economy. But governors have rebelled and many have said they would refuse to entertain the President’s demands. Now they are coming up with their own plans to restart their economies. Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee, and Dr. Jason Kindrachuk, an assistant professor of viral pathogenesis at the University of Manitoba and Canada Research Chair in molecular pathogenesis of emerging and reemerging viruses, joins the show. The coronavirus pandemic has brought China’s amazing economic track record of nearly a half century of continuous growth to an end. Beijing announced yesterday that the economy had shrunk by a massive 6.8 percent in the first three months of the year, ending a streak that had survived Tiananmen Square, SARS, MERS, and even the Great Recession. Brian and John speak with John Ross, Senior Fellow at Chongyang Institute, Renmin University of China, and an award-winning resident columnist with several Chinese media organizations. It’s Friday! So it’s time for the week’s worst and most misleading headlines. Brian and John speak with Steve Patt, an independent journalist whose critiques of the mainstream media have been a feature of his site Left I on the News and on twitter @leftiblog, and Sputnik producer Nicole Roussell.

In this episode, Devona Bell, NCAT director of sustainable agriculture and NCAT's ATTRA sustainable agriculture program, talks with Dr. Sunjya Schweig about the treatment of Lyme disease.Dr. Schweig works with the California Center for Functional Medicine.This episode is the second of a two-part series on the effect of Lyme Disease on farmers and ranchers.In the first part of the series, Devona, who has contracted Lyme Disease twice, spoke with farmers from New Hampshire and Minnesota about how Lyme Disease has affected their families and their farming operations.Be sure to listen to the first part of the series. A link is provided in the notes below.For more information on this topic, you can contact Devona Bell directly via email at devonab@ncat.org.ATTRA Resources:Farmers Battling Lyme Disease. Part 1.Is There an Organic Control for Ticks?Where Can I Find Information on Guinea Fowl Production?Other ResourcesInternational Lyme and Associated Diseases SocietyCalifornia Center for Functional MedicineWhy a 30-Day Elimination Diet?Infectious Disease Society of AmericaOut of the Woods. Healing Lyme Disease – Mind, Body, & SpiritThe Spoon TheoryCowden ProtocolBuhnerProtocol Please call ATTRA with any and all of your sustainable agriculture questions at 1-800-346-9140 or e-mail us at askanag@ncat.org. Our two dozen specialists can help you with a vast array of topics, everything from farm planning to pest management, from produce to livestock, and soils to aquaculture.You can get in touch with NCAT/ATTRA specialists and find our other extensive, and free, sustainable-agriculture publications, webinars, videos, and other resources at NCAT/ATTRA's website.You also can stay in touch with NCAT at its Facebook page.Keep up with NCAT/ATTRA's SIFT farm at its website.Also check out NCAT's Regional Offices' websites and Facebook Pages!Southwest Regional Office: Website / FacebookWestern Regional Office: Website / FacebookRocky Mountain West Regional Office: FacebookGulf States Regional Office: Website / FacebookSo

During this rapidly developing pandemic, it is difficult to stay ahead of the information, much less the viral spread. Dr Kimberly Shriner's talk will focus on coronavirus origin, pathophysiology, clinical presentations and a short review of current proposed therapies. It will be directed for both medical and nonmedical audiences. Bio: Kimberly A. Shriner, M.D., F.A.C.P. A native of Pasadena, Dr. Shriner attended John Muir High School, Occidental College and Case Western School of Medicine. She completed her residency in internal medicine at Huntington Hospital and received her fellowship degree in Infectious Disease from UCLA/Olive View in 1992. Since that time, she has practiced infectious disease and tropical medicine at Huntington Hospital and in the Pasadena community. Dr Shriner has been a faculty member and assistant director for the graduate medical education department at Huntington Hospital. She is the founder and director of The Phil Simon Clinic, a Huntington based outreach clinic for underserved clients with HIV. She is also the founder and President of the Board of The Phil Simon Clinic Tanzania Project, a Pasadena nonprofit organization that, for the last 20 years, has been providing multidisciplinary care for the underserved in Northern Tanzania. Dr. Shriner is a fellow of the American College of Physicians, Infectious Disease Society of America, HIV/MA Association and the International Travel Medicine Society. She has published in peer reviewed journals and continues her research in HIV and aging, zoonotic diseases and global health.

During this rapidly developing pandemic, it is difficult to stay ahead of the information, much less the viral spread. Dr Kimberly Shriner's talk will focus on coronavirus origin, pathophysiology, clinical presentations and a short review of current proposed therapies. It will be directed for both medical and nonmedical audiences. Bio: Kimberly A. Shriner, M.D., F.A.C.P. A native of Pasadena, Dr. Shriner attended John Muir High School, Occidental College and Case Western School of Medicine. She completed her residency in internal medicine at Huntington Hospital and received her fellowship degree in Infectious Disease from UCLA/Olive View in 1992. Since that time, she has practiced infectious disease and tropical medicine at Huntington Hospital and in the Pasadena community. Dr Shriner has been a faculty member and assistant director for the graduate medical education department at Huntington Hospital. She is the founder and director of The Phil Simon Clinic, a Huntington based outreach clinic for underserved clients with HIV. She is also the founder and President of the Board of The Phil Simon Clinic Tanzania Project, a Pasadena nonprofit organization that, for the last 20 years, has been providing multidisciplinary care for the underserved in Northern Tanzania. Dr. Shriner is a fellow of the American College of Physicians, Infectious Disease Society of America, HIV/MA Association and the International Travel Medicine Society. She has published in peer reviewed journals and continues her research in HIV and aging, zoonotic diseases and global health.

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Mohammad Marandi. He is an expert on American studies and postcolonial literature who teaches at the University of Tehran.Although the Coronavirus pandemic is wreaking havoc inside the United States, Donald Trump is lashing out at Iran once again. The sanctions regime the United States has imposed on Iran is pushing the country’s public health system to the brink, but now Trump is ludicrously accusing Iran of plotting to attack the United States. Coronavirus cases continue to worsen on an exponential basis, with nearly one million cases now documented around the world. The United States now has nearly a quarter million documented cases and now a single county or municipality in America has been spared. But there may be some good news. Social distancing and quarantines appear to be helping to slow the spread of the disease in places like Washington State and California. And even Italy has seen a two-day decline in the number of new cases. Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee, joins the show. Thursday’s weekly series “Criminal Injustice” is about the most egregious conduct of our courts and prosecutors and how justice is denied to so many people in this country. Paul Wright, the founder and executive director of the Human Rights Defense Center and editor of Prison Legal News (PLN), and Kevin Gosztola, a writer for Shadowproof.com and co-host of the podcast Unauthorized Disclosure, join the show. Wednesday’s weekly series, In the News, is where the hosts look at the most important ongoing developments of the week and put them into perspective. Sputnik news analysts Nicole Roussell and Walter Smolarek join the show. A regular Thursday segment deals with the ongoing militarization of space. As the US continues to withdraw from international arms treaties, will the weaponization and militarization of space bring the world closer to catastrophe? Brian and John speak with Prof. Karl Grossman, a full professor of journalism at the State University of New York, College at Old Westbury and the host of a nationally aired television program focused on environmental, energy, and space issues, and with Bruce Gagnon, coordinator of the Global Network Against Weapons & Nuclear Power in Space and a contributor to Foreign Policy In Focus.

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Dr. Krutika Kuppalli, an infectious disease physician and vice chair of an Infectious Disease Society of America committee, and Dr. Jason Kindrachuk, an assistant professor of viral pathogenesis and Canada Research Chair in molecular pathogenesis of emerging viruses.Public institutions across the country are shutting down and the stock market continued to collapse at its open as the coronavirus pandemic continues to grip the country and the world. However, Coronavirus tests remain scarce and many workers remain without paid sick leave due to huge exemptions written into the relief bill passed at the end of last week. Bernie Sanders and Joe Biden faced off in their first one on one debate last night. The candidates faced questions about the coronavirus crisis, healthcare, foreign policy and more ahead of another round of crucial primaries scheduled for Tuesday. Dave Lindorff, an investigative reporter, a columnist for CounterPunch, and a contributor to The Nation, Extra! and Salon.com, whose writings are at ThisCantBeHappening.net, joins the show. Monday’s segment “Education for Liberation with Bill Ayers” is where Bill helps us look at the state of education across the country. What’s happening in our schools, colleges, and universities, and what impact does it have on the world around us? Bill Ayers, an activist, educator and the author of the book “Demand the Impossible: A Radical Manifesto,” joins Brian and John. In this segment, The Week Ahead, the hosts take a look at the most newsworthy stories of the coming week and what it means for the country and the world, including the coronavirus pandemic, yesterday’s debate in the race for a democratic presidential nominee, and more. Sputnik News analysts and producers of this show Nicole Roussell and Walter Smolarek join the show.

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Michele Greenstein, a correspondent with RT America.Today is Super Tuesday 2.0 with primary elections in Michigan, Washington state, Missouri, Mississippi, Idaho, and North Dakota. Michigan is a must-win state for Bernie Sanders, which he carried over Hillary Clinton in 2016. And all eyes are on Mississippi as pundits look to the numbers of African American voters who will go to the polls for Joe Biden. As the coronavirus spreads across the United States and around the world, Italy has literally closed. The entire country has put itself in quarantine. International flights and cruises are being canceled. People are hoarding toilet paper, canned food, and water. And we still don’t have enough test kits available to health professionals. Is the government response enough to keep Americans safe? Should we be doing more? Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee, joins the show. There was no disguising the tension today at the European Commission during talks between Turkish President Erdogan and the two EU presidents on Turkey’s new policy of pushing Syrian and other refugees across the Greek border by force. The Europeans insisted that the Turks abide by an earlier agreement providing Ankara with funding to handle the refugee crisis inside Turkey. Erdogan skipped the post-meeting press conference and went straight to the airport. Brian and John speak with Ambassador Robert Pearson, a former US Ambassador to Turkey and former Director General of the US Foreign Service and a non-resident scholar at the Middle East Institute, focusing on US-Turkish relations. Chinese President Xi Jinping made a surprise visit to Wuhan, the city where the coronavirus outbreak began. Xi announced that the virus had been contained as cases in Wuhan drop dramatically. As the number of coronavirus victims skyrocket around the world, the number has plummeted in China. KJ Noh, a peace activist and scholar on the geopolitics of Asia, and a frequent contributor to Counterpunch and Dissident Voice, joins the show. Julian Assange’s extradition hearings in London are on hiatus while US authorities regroup and hone their strategy to have the Wikileaks co-founder sent to the United States for trial on espionage charges. In the first round of hearings, the British judge exhibited disturbing bias in favor of US and British authorities. The next round will begin in a little more than a month. But what is the role of the European Court of Human Rights? Steve Poikonen, host of the Slow News Day podcast and cohost of the Free Assange online vigil series, joins Brian and John. Today is Loud & Clear’s weekly series about the biggest economic news of the week with special guest -- Prof. Richard Wolff. Professor Wolff, a professor of Economics Emeritus, University of Massachusetts, Amherst and founder of the organization Democracy at Work whose latest book is “Understanding Socialism,” joins the show.Tuesday’s regular segment is called Women & Society with Dr. Hannah Dickinson. This weekly segment is about the major issues, challenges, and struggles facing women in all aspects of society. Hannah Dickinson, an associate professor at Hobart and William Smith Colleges and an organizer with the Geneva Women’s Assembly; Nathalie Hrizi, an educator, a political activist, and the editor of Breaking the Chains, a women’s magazine, which you can find at patreon.com/BreakChainsMag; and Loud & Clear producer Nicole Roussell join the show.

We review the evaluation and management of Community-Acquired Pneumonia (CAP) as well as the Infectious Disease Society of America (IDSA) / American Thoracic Society (ATS) 2019 guidelines for CAP. Shownotes and references at FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer

On today's episode of Loud & Clear, Brian Becker and John Kiriakou are joined by Ted Rall, an award-winning editorial cartoonist and columnist, whose work is at www.rall.com, and Dan Kovalik, a human rights and labor lawyer who is the author of the book “No More War: How the West Violates International Law by Using 'Humanitarian' Intervention to Advance Economic and Strategic Interests.”Yesterday was Super Tuesday and it was a very big day for Joe Biden. Two weeks ago it looked like the former Vice President’s campaign was all but dead. But yesterday he became the clear frontrunner, besting Bernie Sanders in 10 of the 14 state contests. Biden won in Alabama, Arkansas, Maine, Massachusetts, Minnesota, North Carolina, Oklahoma, Tennessee, Texas, and Virginia. Sanders won in California, Colorado, Utah, and Vermont. Mike Bloomberg took American Samoa and then dropped out of the race this morning. But in the end, is it Donald Trump who was really the big winner? The peace agreement between the United States and the Taliban appears to have lasted about a few days. The US carried out an airstrike this morning against Taliban fighters who had apparently attacked an Afghan National Defense and Security Forces checkpoint. The airstrike came hours after President Trump called Taliban leader Mullah Abdul Ghani Baradar to warn him not to resume violence against the Afghan government. Kathy Kelly, co-coordinator of Voices for Creative Non-Violence, joins the show. The coronavirus continues to spread and, according to the World Health Organization, is now deadlier than the flu virus. It does not, however, transmit as easily as the flu, and scientists around the world are working on a vaccine. Meanwhile, new cases of the virus have been confirmed in New York City, Florida, and California. And for the first time, there have been more deaths from coronavirus outside China than in. Brian and John speak with Dr. Krutika Kuppalli, an infectious disease physician and vice chair of the Infectious Disease Society of America’s Global Health Committee. Wednesday’s weekly series, In the News, is where the hosts look at the most important ongoing developments of the week and put them into perspective, including Super Tuesday, the coronavirus outbreak, the war in Syria, and the war in Afghanistan. Sputnik news analysts Nicole Roussell and Walter Smolarek join the show. Wednesday’s regular segment, Beyond Nuclear, is about nuclear issues, including weapons, energy, waste, and the future of nuclear technology in the United States. Kevin Kamps, the Radioactive Waste Watchdog at the organization Beyond Nuclear, and Sputnik news analyst and producer Nicole Roussell, join the show.

Matthew DeLaney, MD  and Rick Pescatore, DO discuss the new IDSA updates regarding the diagnosis, disposition and treatment of patients with possible community acquired pneumonia. There is so much more to Urgent Care RAP each month? Click Here to hear more of what you need to be ready each day and we'll toss in 42 CME hours per year to boot. Pearls: When considering influenza, patients should be tested using NAAT rather than diagnosed clinically. Patients with test proven influenza and infiltrates on CXR should receive oseltamivir, regardless of duration of symptoms, in addition to appropriate antibiotics Patients should be risk stratified using a clinical decision tool, preferably PSI/PORT score,  to determine who is likely to benefit most from hospital admission. Procalcitonin is no longer recommended in the initial evaluation of patients with possible pneumonia.  At the end of 2019, the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) released the first update of the treatment guidelines for community acquired pneumonia (CAP) in >10 years.  IDSA now recommends more routine testing for influenza using nucleic acid amplification testing (NAAT) for influenza because of enhanced sensitivity of NAAT compared to older antigen based testing (>90% vs. ~50% sensitivity).  The IDSA now recommends that patients with test proven influenza and an infiltrate on CXR receive oseltamivir (regardless of duration of symptoms) in addition to appropriate antibiotics. 30% of deaths from influenza come from bacterial co-infection.  IDSA recommends risk stratifying patients with a Pneumonia Severity Index (PSI)/PORT score and recommends against relying heavily on a CURB-65 score to determine which patients will benefit from hospitalization.  Several questions on the PSI rely on lab testing which may not be available in UC, however, the parameters give guidance to factors associated with higher risk of adverse outcomes in patients with pneumonia. https://www.mdcalc.com/psi-port-score-pneumonia-severity-index-cap Clinical gestalt and assessment are also critical. Patients who appear ill and/or show signs of respiratory distress should be referred immediately to an ED. The guidelines also discuss major and minor criteria suggesting need for ICU admission including need for intubation, hypotension, tachypnea, and multilobar infiltrates. Multilobar pneumonia is a concerning finding and an independent predictor of poor outcome.  All patients with multilobar pneumonia should be referred to an ED for further evaluation. These guidelines suggest that, based on the low quality of evidence supporting utility, procalcitonin is no longer recommended in the diagnosis or treatment of CAP. There may be some limited utility in specific patients (mostly hospital inpatients) however, so this test is probably not going away, but having access to PCT testing from UC shouldn’t be a priority.    References: Metlay JP, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PubMed PMID: 31573350 https://www.thennt.com/nnt/corticosteroids-treating-pneumonia/ Eliakim-Raz N, et al. Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults. Cochrane Database Syst Rev.  2012 Sep 12;(9):CD004418. doi: 10.1002/14651858.CD004418.pub4. Review.PubMed PMID: 22972070.

Most people understand the importance of a healthy gut microbiome for digestive health and overall wellbeing. But what about the mycobiome―the fungi that live inside our bodies? This podcast introduces this important component of the microbiome and explains how diet affects this population and how its balance or imbalance can cause you to feel―a poor balance of fungi can lead to weight gain, pain and bloating, and low energy, and can worsen symptoms for those with IBS or Crohn’s. Good news: Gut fungi respond quickly and dramatically to dietary and lifestyle changes. Within 24 hours, you can remake your mycobiome, supporting a path to weight loss, better digestion, and more energy. Alongside this accessible gut science, my guest, Dr. Mahmoud Ghannoum, author of the new book "" outlines fast changes for fostering healthy fungi as well as 7- and 20-day diet plans, with more than 50 dietician-tested recipes, to cultivate a thriving mycobiome and methods for tweaking your lifestyle for long-term gut health. Dr. Ghannoum is a tenured professor and director of the Center for Medical Mycology at Case Western Reserve University and University Hospitals Cleveland Medical Center in Cleveland, Ohio. Educated in Lebanon, England, and the United States, he received his PhD in Microbial Physiology from University of Technology in England and an Executive MBA from the Weatherhead School of Management at Case Western Reserve University. He has spent his entire career studying medically important fungi and publish-ing extensively about their virulence factors, especially in microbial biofilms. Over the past decade, Dr. Ghannoum recognized the role of the microbial community (both bacterial and fungal) in human health and published the first study describing the oral fungal community, coining the term“mycobiome.”He described the bacterial microbiome (bacteriome) and the mycobiome in HIV-infected patients, and led the characterization of the interaction between bacteria and fungi as they relate to health and disease. In 2016, he published an opinion piece in The Scientist on the contribution of the myco-biome to human health and was consequently invited to speak at a number of meetings organized by the National Institutes of Health. He conducted a study characterizing the bacterial and fungal communities in Crohn’s disease patients that resulted in the first model of microbiome dysbiosis that implicated cooperation between bacteria and fungi in biofilms. This work resulted in a publication that received national and international coverage. Dr. Ghannoum is also a fellow of the Infectious Disease Society of America and a past President of the Medical Mycological Society of the Americas (MMSA). He has received many distinguished awards for his research, and in 2013, he was selected as“MostInteresting Person” by Cleveland Magazine. In 2016, he received the Rohda Benham Award presented for his continuous out- standing and meritorious contributions to medical mycology from the Medical Mycological Society of the Americas and the Freedom to Discover Award from Bristol-Myers Squibb for his work on microbial biofilms. In 2017, he was inducted as a fellow of the American Academy of Microbiology. He continues to be a pioneer in the characterization of the human microbiome. With over 400 peer-reviewed publications to his credit and six published books on antifungal therapy, microbial biofilms, Candida adherence, and related topics, Dr. Ghannoum continues to be a prominent leader in his field. The National Institutes of Health has continually funded his research since 1994, and he recently received a large NIH grant to study the mechanism(s) of bacterial/fungal interaction in intestinal inflammation, such as in colitis and Crohn’s disease. He has also consulted for many international pharmaceutical and biotech companies, and co-founded multiple successful and profitable companies, including BIOHM Health, launched in 2016, that engineer products and services to address the critical role of the bacterial and fungal com-munities in digestive and overall health and wellness. BIOHM Health was just awarded the Science and Innovation Award by Nutrition Business Journal. He lives in Cleveland with his wife, children, and grandchildren. During our discussion, you'll discover: -The story behind Dr. Ghannoum coining the term "mycobiome"...7:40 Mycology is the study of fungi; mycobiome refers to the fungi in our gut and parts of our body Focusing just on bacteria leads to overgrowth of candida Showed through research that over 100 fungal species exist in a typical human mouth -Why the human body benefits from having fungus inside it...10:15 We need fungi in our gut; good fungi, even candida in low doses, helps the body Helps in breaking down, fermenting food Candida or fungi at colonizer level cleans the immune system Gut Report to test fungus levels in the body Other microbiome tests examine the bacteria only -What are good and bad fungi, or are fungi levels the only factor?...14:18 It varies by the species Saccharomyces boulardii and Pichia are good all the way around The level of candida is the determining factor, good or bad There are different strains of candida -Signs and symptoms of a fungal overgrowth...18:32 Diarrhea Allergies Pain in the GI tract Damage to gut lining results -How biofilms protect the gut...21:38 Candida cooperates w/ E. coli and Serratia Marcescens (both pathogens) make a biofilm Plack on teeth is an example of a biofilm Organisms in the gut are not free floating; they stick to the gut Complex polysaccharides form around organisms; shields from drugs or immune cells Biofilms are resistant to being broken down Echinocandins inhibit the synthesis of the fungal cell wall: Caspofungin Micafungin Anidulafungin -How people get fungal infections...29:00 Immunocompromised patients typically have lots of antibiotics (killing useful bacteria and allowing candida overgrowth) Goes through GI tract and attacks blood Nurses and doctors  are carriers Surgery Steroids exacerbate susceptibility to candida infections -Differences and similarities between SIFO and SIBO...35:40 Similar symptoms Nausea is more prevalent and severe in SIFO patients Abdominal pain and gas is more prevalent in SIBO SIFO patients grow candida 19% of patients can have both SIBO and SIFO -How popular diets may contribute to fungal overgrowth...39:05 Mediterranean diet: Lots of grains, carbs, pasta (can encourage growth of candida) Follow the diet, provided you consume alcohol in moderation (sugars are problematic) Paleo diet may contain too little prebiotic content Mycobiome diet is customizable to the individual -What life looks like on the mycobiome diet...46:10 Goal is to limit growth of candida, and pro-inflammatory bacteria  People low in Vitamins A,B,C are vulnerable Encourage beneficial bacteria (fibers, resistance starches) Stop biofilms (harming gut lining and causing inflammation) Cruciferous veggies are anti-inflammatory and antioxidant The best food can still result in imbalance in the gut Lifestyle factors: Exercise, walk, hike, etc. Blood can divert from the heart, lungs during extreme exercise No full-fat dairy Herbs and spices that are particularly efficacious: Coconut oil Turmeric  Garlic Apple cider vinegar Supplements Probiotic w/ Saccharomyces boulardii (Biohm) Multivitamin w/ Vitamin A,B,C   Sample breakfast: Steel cut oatmeal w/ bananas, berries, honey Egg w/ tomatoes, turmeric, olives Sample lunch: Lentil soup, spring onions, lemon, chicken Salad w/ cucumber, spring onion, garlic, lettuce, salmon Pistachios are great for the biome Sample dinner: Asparagus, cauliflower, Brussels sprouts Chicken roasted, fish -How to find a physician who is knowledgeable in treating SIFO...1:05:11 -And much more... Resources from this episode: - - - - Episode sponsors: Boundless:  And click for info regarding the book launches coming up in NYC and Los Angeles! -: Building blocks for muscle recovery, reduced cravings, better cognition, immunity, and more. Get 10% off your order of Kion Aminos, and everything at the Kion site when you use discount code "bgf10" at checkout. -: Grow muscle 3x faster than you can with free weights! The X3 Bar will change the way you train forever. Get a $50 discount off your X3 bar when you use discount code: BEN -: Seriously comfortable compression socks designed to support your every move. Receive 20% off your Comrad purchase when you use discount code: KION -: Delivers healthy 100% grass-fed and finished beef, free-range organic chicken, and heritage breed pork directly to your door on a monthly basis. All their products are humanely raised and NEVER given antibiotics or hormones. For 2 lbs of 100% grass-fed beef and 2 lbs of pure bacon for FREE, PLUS $20 off your first box go to ButcherBox.com/BEN OR enter promo code BEN20 at checkout. Do you have questions, thoughts or feedback for Dr. Mahmoud Gannoum or me? Leave your comments below and one of us will reply!

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Randy Taplitz from UC San Diego Health, lead author on Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. Thank you for being here, Dr. Taplitz. Thank you. So first, can you give us a general overview of what this guideline covers? Yes. I mean, I think we're all aware that infection in the setting of neutropenia associated with cancer chemotherapy is really a major cause of morbidity in these patients. And it's also important to be aware that prevention and appropriate management of febrile neutropenia and infection should thus be a critical focus in cancer care. So the focus of this particular guideline was to evaluate the risk and benefits of antimicrobial prophylaxis in these patients and really to determine evidence-based best practices for prevention of infection and how to go about doing that. So In this guideline, what we do is we identify the groups at risk for febrile neutropenia and really recommend settings for which prophylaxis with antibacterial, antifungal, antiviral medications are indicated. And then as well make recommendations for consideration of vaccination and other measures such as respiratory etiquette, and hand hygiene, and the like that will help reduce the risk of infection in these vulnerable patients. So since this is an update of a 2013 guideline, what are the major changes? And can you tell us a little bit about the research that informed this update? Yes. Really, when you update a guideline, one is informed by review of articles that encompass, in this setting, randomized clinical trials as well as meta analysis of interventions to prevent microbial infections in patients with neutropenia or other types of immunosuppression. And one example of this-- I think one of the better examples-- is we reviewed a large meta analysis of antibiotic prophylaxis in neutropenic patients after chemotherapy that showed that for fluoroquinolone prophylaxis resulted in really significant reductions in all cause mortality and febrile episodes, particularly in patients who were high risk, meaning the hematologic malignancy population and stem cell transplant population. And in that particular population, in fact, the number needed to treat to prevent one death was 29. So therefore, in that high risk population, really as with prior guidelines, the fluoroquinolone prophylaxis is recommended. However, we also reviewed other articles that include emerging data on some of the risks of fluoroquinolone prophylaxis. So for instance, the effect of fluoroquinolone on the intestinal microbiome and its association with selection of fluoroquinolone-resistant bacteria such as Gram-negative rods, as well as selection of organisms such as Clostridium difficile and enterococcus. And then we also reviewed fluoroquinolone toxicities. So what is added to this guideline are some qualifying statements alerting clinicians to really be aware for these concerns and to consider what the clinical spectrum of things like Clostridium difficile infection, et cetera, look like. In terms of antifungal prevention, including pneumocystis prevention, we really haven't made any major changes to this guideline with the exception that in this new guideline, the panel has also started looking at complications associated with immunotherapy and actually makes a suggestion that people consider pneumocystis prophylaxis in the setting of prolonged steroid use when it's used to treat immune-related adverse events that we've begun to see in increasing numbers associated with agents like checkpoint inhibitors and other immunotherapies. In terms of viral infections, the updated guidelines recommend risk assessment for hepatitis B reactivation and then treatment in accordance with other ASCO guidelines and yearly influenza vaccine, as well as really endorsing other vaccines as described in the Infectious Disease Society of America Guideline for Vaccination in Immunocompromised Hosts. So really, those are the main new events since 2013. And what are the key recommendations of this guideline? So the key recommendations-- the first thing is what we call a risk assessment. So after-- what one does is carefully assess, really, what the risk of febrile neutropenia is. And that includes assessment of patient, what the cancer is, and what the treatment-related factors are. And then after they're risk adjusted and risk assessed, then we take, in turn, different forms of prophylaxis that we consider. And so the first one that we always consider is antibiotic prophylaxis against bacterial infections. And the recommendation is still with the fluoroquinolone. And that's recommended for most patients who are at high risk for febrile neutropenia or profound, really prolonged neutropenia, such as those getting therapy for AML, or myelodysplastic syndrome, or stem cell transplant recipients, particularly with myeloablative regimens. In the lower risk groups, such as those with most solid tumors, fluoroquinolone prophylaxis is not recommend. In terms of antifungal prophylaxis, what is recommended is an oral triazole or Micafungin-- for patients, again, at risk for profound protracted neutropenia such as that AML, MDS, stem cell transplant group during that period of neutropenia. When the risk of invasive aspergillus is high, such as in patients with AML or MDS during the neutropenia period while getting chemotherapy, then the consideration of a mold-active triazole is recommended and in addition should be considered in the context of stem cell transplant recipients with graft versus host disease. In terms of PCP prophylaxis, PCP preventive therapies are recommended for those at high risk for PCP, which include those on greater than what we say 20 milligrams of prednisone equivalent a day for over a month, or based on purine analog use. Viral prophylaxis for HSV is recommended for seropositive patients undergoing allogeneic stem cell transplant or leukemia induction. And then as I mentioned before, patients at risk for hepatitis B reactivation are recommended treatment with a nucleoside reverse transcriptase inhibitor. And this is more carefully discussed in the ASCO Provisional Clinical Opinion on Hepatitis-B Virus Screening for Patients With Cancer Before Therapy. It's also recommended that a yearly flu vaccine is given to patients as well as given to family, household contacts, and health care workers. Other vaccination recommendations are as per the Infectious Disease Society of America Guidelines for Vaccination of Immunocompromised Hosts. And then the other things that are recommended are really review and repeat recommendation of adherence with hand hygiene, with respiratory etiquette, which is recommended and really required for all health care workers. And that out patients with neutropenia from cancer chemotherapy should avoid high risk activities, which include really contact with environments that have high concentration of fungal spores such as construction and demolition, high intensity gardening, et cetera. So those are really a summary of the key recommendations of this guideline. And finally, how will these guideline recommendations affect patients? I think it's important to remember that to ensure best practices on infection prevention, the literature needs to be reviewed frequently and guidelines need to be updated. I don't think that these current guidelines will dramatically change the preventive strategies that are used for patients, with the exception of perhaps a few extra vaccines-- some newer indications for pneumocystis prevention, hepatitis B reactivation prevention, those kinds of things. However, I think in reviewing the literature, it becomes clear what will we will need to be thinking about in the coming years, what we will need to be assessing. And a couple of those things are the dramatic increase in the use of immune-based therapies and how that will affect infection risk in patients with or without neutropenia. We need to be considering the effects of routine antibiotic prophylaxis on the microbiome and the risks that that might incur. And we need to really understand how new vaccines can be utilized. So yeah, I think these areas are really ripe for research and need to be followed closely to ensure optimization of these preventive strategies for our patients in the future. Thank you for your time today, Dr. Taplitz. You're quite welcome. And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. If you've enjoyed what you heard today, please rate and review the podcast and refer this show to a colleague.

Lyme disease. So much we seem not to know, in many different areas. Draft guidelines for the diagnosis and treatment of Lyme disease were recently issued by the Infectious Disease Society of America (IDSA)--two really big, contentious issues. And of course there are the disagreements of how the various organizations view these Lyme topics--I've often termed this the establishment vs. the advocates. My guest today took a look at this in a recent two-part series in Forbes entitled "Lyme Wars". Joining me is the author and infectious disease physician, Judy Stone, MD.

By Robert Herriman  @infectiousdiseasenews Lyme disease. So much we seem not to know, in many different areas. Draft guidelines for the diagnosis and treatment of Lyme disease were recently issued by the Infectious Disease Society of America (IDSA)–two really big, contentious issues. And of course there are the disagreements of how the various organizations view […] The post Lyme disease: The major players, the disagreements and the IDSA draft guidelines appeared first on Outbreak News Today.

Dr. DuBois Past President of Atlanta Infectious Disease Society talking with Juice Plus partners. --- Support this podcast: https://anchor.fm/darryl-horton/support

In this episode, we discuss important and "hot" articles thus far in 2019. These articles include: Testing for pulmonary embolism in pregnant patients Van der pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019;380(12):1139-1149. Langlois E, Cusson-dufour C, Moumneh T, et al. Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study. J Thromb Haemost. 2019; In Press Asymptomatic bacteriuria guidelines from the Infectious Disease Society of America (IDSA) Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019. Dosing of benzodiazepines in seizures Sathe AG, Tillman C, Coles LD, et al. Underdosing of benzodiazepines in patients with status epilepticus enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019 Jun 4. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma patients Joseph B et al. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma. JAMA Surg 2019. Mar 20. Mortality following opioid overdose Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2019; In Press Thanks for listening! Jeremy Faust and Lauren Westafer

On this episode we give a brief overview of the management of both hepatitis A and B. We also review ACIP immunization recommendations for both diseases. This review only covers the surface of these disease and we greatly encourage you to read further on your own. Below is the link to the Infectious Disease Society of America guidelines: https://www.idsociety.org/globalassets/idsa/practice-guidelines/chronic_hep_b_update_2009-8_24_2009.pdf If you have any questions, reach out to us on any of the following: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.  

Yes I know I probably ruffled some feathers but to those who got upset, I say how can you help them see if you refuse to talk to them? And it seems everyone, has been trying to get this interview but I do my bet to Lead with Love and be nonconfrontational and respectful which has led to me be able to actually speak cordially with Paul on many occasions. Folks be the change you want to see is all I can say. I will never Lose hope that Paul will see the truth along with the many others I am trying to wake up. Paul A. Offit, MD is the Director of the Vaccine Education Center at the Children's Hospital of Philadelphia as well as the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, and a Research Career Development Award from the National Institutes of Health. Dr. Offit has published more than 160 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC; for this achievement Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases; and was honored by Bill and Melinda Gates during the launch of their Foundation's Living Proof Project for global health. In 2009, Dr. Offit received the President's Certificate for Outstanding Service from the American Academy of Pediatrics. SEE FULL BIO ON FACEBOOK EVENT wouldn't fit lol

Kent Holtorf, M.D. is the medical director of the Holtorf Medical Group, and a founder and director of the non-profit National Academy of Hypothyroidism (NAH). He has trained numerous physicians across the country in the use of bioidentical hormones, hypothyroidism, complex endocrine dysfunction, and innovative treatments for chronic fatigue syndrome, fibromyalgia, and chronic infectious diseases, including Lyme and its co-infections. Lyme, in particular, has been the focus of the Holtorf Medical Group and has been a passion of Dr. Holtorf’s – not least because he, himself, lives with chronic Lyme. He is also a fellowship lecturer for the American Board of Anti-Aging Medicine, the Endocrinology expert for AOL, and is a guest editor and peer reviewer for a number of medical journals, including Endocrine, Postgraduate Medicine, and Pharmacy Practice. He has published innumerable studies and papers on his various topics of interest and expertise. Dr. Holtorf has helped to demonstrate that much of the long-held dogma in endocrinology and infectious disease is backed by evidence that proves it is inaccurate. He is also a contributing author to Denis Wilson’s Evidence-Based Approach to Restoring Thyroid Health. He has been a featured guest on many TV shows, including CNBC, ABC News, CNN, Discovery Health, TLC, The Today Show, and CBS Sunday Morning; in addition, he has been featured in print in The Wall Street Journal, LA Times, US News and World Report, SF Chronicle, WebMD, Health, Elle, Better Homes and Gardens, Forbes, the NY Daily News, and Self magazine – among many others. He joins Lauren on this episode to discuss his work at the forefront of chronic illness and thyroid medicine, medical “quackery” and evidence-based approaches not yet recognized by larger medical organizations, the need for healthcare reform in the US and how this might be achieved, and his own struggles with Lyme, which have greatly informed his methodologies and patient-centered care approach. Listen in as Dr. Holtorf shares…  - about being both a survivor of chronic illness (Lyme) and a practitioner  - how so many medical practitioners who treat chronic illness came to alternative/integrative/experimental treatments because they themselves were once sick  - that societal guidelines are far more restrictive and often less evidence-based than innumerable anecdotal cases, particularly with regard to chronic diseases like Lyme – and how organizations like ILADS and the Infectious Disease Society of America still don’t even classify Lyme as a chronic illness despite the mounting evidence to the contrary  - that the fatigue of chronic illness is entirely different from general fatigue  - that he first went into anesthesia because he was so fatigued, and he knew this field would keep conversations with patients – which were further exhausting him – to a minimum  - that he started attending “alternative medicine” conferences, and found the studies and practitioners coming out of these events were far more evidence-based than the materials with which he was presented in medical school and in residency  - that he worked on optimizing his hormones to get well  - how everyone’s “normal” is different  - the studies from his Fibromyalgia and Fatigue Centers (FFC), which indicated that most patients saw – on average – 7.2 physicians without improvement in chronic symptoms (current numbers are more like 12-14 physicians without improvement in symptoms)  - how care in the US has become more segmented, and it’s deteriorating  - that doctors are the least empathetic group he’s ever seen  - what doctors are working against: the business model of health insurance (which is tied into quantity over quality, time restraints, and big pharma); ego and self-esteem issues  - how quickly his work has been dismissed as “quackery”  - how few practitioners can’t – and often don’t want – to take the time to find the source of chronic and invisible illness  - the stress connection to health – it can devastate the immune response and be a huge factor in chronic illness  - that he knew he had Lyme – and his blood was so thick he had to wait months to thin it out in order to properly test it  - that he used antibiotics for 4.5 years – and would never prescribe them that long for ANY patient  - that he is a fan of Ozone, LDN, stem cells, and peptides for treatment of specific chronic illnesses, and has used these therapies himself  - if you don’t fix the immune system, you won’t get rid of the infection; his ethos is root-cause based for this reason  - his whole life, he was never able to get out of bed before noon. Now, he is much more highly functional  - the chronic illness cycle of rest and anxiety when you can’t get to sleep despite total body and mind fatigue  - his take on the opioid crisis: that so many highly addictive opiates have been approved by the FDA because of special interest groups and big pharma  - the frustrations of the rising cost of medication  - how the US has the least free-market healthcare system in the world, despite our acceptance of capitalism – and how this is entirely tied to big dharma  - the frustration of communication between “standard” Western doctors and the more “experimental” medical establishment  - placebo doesn’t work in chronically ill patients in the same way it does in “well” patients – it’s more of a “no-cebo” among the chronically ill  - that the sicker the thyroid patient, generally…the more T3 they need (combo therapy of T3 and T4)  - that doctors are taught to memorize and to segment the body, rather than understanding multi-system symptoms and treatment  - the cost of chronic illness  - that Lyme is often misdiagnosed as Parkinson’s, ALS, and MS – among other conditions  - that his Lyme disease was initially misunderstood as HIV/AIDS because his immune system was so incredibly suppressed  - that coagulation of the blood is common among immune-suppressed patients  - that he is in favor of universal healthcare, but fixing our system is not as simple as that – it also requires a free market and reduced prescription costs, as well as a removal of price-fixing among big pharmaceutical companies  - restrictions on publishing medical studies: even medical journals are funded by big pharma ads, which presents a conflict of interest and some collusion  - that he encourages healthy, informed debate over angry outbursts 

Yes I know I probably ruffled some feathers but to those who got upset, I say how can you help them see if you refuse to talk to them? And it seems everyone, has been trying to get this interview but I do my bet to Lead with Love and be nonconfrontational and respectful which has led to me be able to actually speak cordially with Paul on many occasions. Folks be the change you want to see is all I can say. I will never Lose hope that Paul will see the truth along with the many others I am trying to wake up. Paul A. Offit, MD is the Director of the Vaccine Education Center at the Children's Hospital of Philadelphia as well as the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, and a Research Career Development Award from the National Institutes of Health. Dr. Offit has published more than 160 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC; for this achievement Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases; and was honored by Bill and Melinda Gates during the launch of their Foundation's Living Proof Project for global health. In 2009, Dr. Offit received the President's Certificate for Outstanding Service from the American Academy of Pediatrics. In 2011, See Facebook for full Bi

I will be interviewing none other than Dr. Paul Offit. Yes I know I will ruffle many feathers but to those who get upset I say how can you help them see if you refuse to talk to them. And it seems everyone, has been trying to get this interview but I do my bet to Lead with Love and be nonconfrontational and respectful which has led to me be able to actually speak cordially with Paul on many occasions. Folks be the change you want to see is all I can say. I will never Lose hope that Paul will see the truth along with the many others I am trying to wake up.  Paul A. Offit, MD is the Director of the Vaccine Education Center at the Children's Hospital of Philadelphia as well as the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, and a Research Career Development Award from the National Institutes of Health. Dr. Offit has published more than 160 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC; for this achievement Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, the Charles Mérieux Award from the National Foundation for Infectious Diseases; and was honored by Bill and Melinda Gates during the launch of their Foundation's Living Proof Project for global health. In 2009, Dr. Offit received the President's Certificate for Outstanding Service from the American Academy of Pediatrics. SEE FULL BIO ON FACEBOOK EVENT wouldn't fit lol

On this episode, we are joined once again by Tom Klvana, PA-C. We discuss the updated 2018 guidelines for the treatment of C. diff that were published by the Infectious Disease Society of America.  If you have any questions, reach out to us on any of the following: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Randy Taplitz from UC San Diego Health, lead author on Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. Thank you for being here, Dr. Taplitz. Thank you. So first, can you give us a general overview of what this guideline covers? Yes. I mean, I think we're all aware that infection in the setting of neutropenia associated with cancer chemotherapy is really a major cause of morbidity in these patients. And it's also important to be aware that prevention and appropriate management of febrile neutropenia and infection should thus be a critical focus in cancer care. So the focus of this particular guideline was to evaluate the risk and benefits of antimicrobial prophylaxis in these patients and really to determine evidence-based best practices for prevention of infection and how to go about doing that. So In this guideline, what we do is we identify the groups at risk for febrile neutropenia and really recommend settings for which prophylaxis with antibacterial, antifungal, antiviral medications are indicated. And then as well make recommendations for consideration of vaccination and other measures such as respiratory etiquette, and hand hygiene, and the like that will help reduce the risk of infection in these vulnerable patients. So since this is an update of a 2013 guideline, what are the major changes? And can you tell us a little bit about the research that informed this update? Yes. Really, when you update a guideline, one is informed by review of articles that encompass, in this setting, randomized clinical trials as well as meta analysis of interventions to prevent microbial infections in patients with neutropenia or other types of immunosuppression. And one example of this-- I think one of the better examples-- is we reviewed a large meta analysis of antibiotic prophylaxis in neutropenic patients after chemotherapy that showed that for fluoroquinolone prophylaxis resulted in really significant reductions in all cause mortality and febrile episodes, particularly in patients who were high risk, meaning the hematologic malignancy population and stem cell transplant population. And in that particular population, in fact, the number needed to treat to prevent one death was 29. So therefore, in that high risk population, really as with prior guidelines, the fluoroquinolone prophylaxis is recommended. However, we also reviewed other articles that include emerging data on some of the risks of fluoroquinolone prophylaxis. So for instance, the effect of fluoroquinolone on the intestinal microbiome and its association with selection of fluoroquinolone-resistant bacteria such as Gram-negative rods, as well as selection of organisms such as Clostridium difficile and enterococcus. And then we also reviewed fluoroquinolone toxicities. So what is added to this guideline are some qualifying statements alerting clinicians to really be aware for these concerns and to consider what the clinical spectrum of things like Clostridium difficile infection, et cetera, look like. In terms of antifungal prevention, including pneumocystis prevention, we really haven't made any major changes to this guideline with the exception that in this new guideline, the panel has also started looking at complications associated with immunotherapy and actually makes a suggestion that people consider pneumocystis prophylaxis in the setting of prolonged steroid use when it's used to treat immune-related adverse events that we've begun to see in increasing numbers associated with agents like checkpoint inhibitors and other immunotherapies. In terms of viral infections, the updated guidelines recommend risk assessment for hepatitis B reactivation and then treatment in accordance with other ASCO guidelines and yearly influenza vaccine, as well as really endorsing other vaccines as described in the Infectious Disease Society of America Guideline for Vaccination in Immunocompromised Hosts. So really, those are the main new events since 2013. And what are the key recommendations of this guideline? So the key recommendations-- the first thing is what we call a risk assessment. So after-- what one does is carefully assess, really, what the risk of febrile neutropenia is. And that includes assessment of patient, what the cancer is, and what the treatment-related factors are. And then after they're risk adjusted and risk assessed, then we take, in turn, different forms of prophylaxis that we consider. And so the first one that we always consider is antibiotic prophylaxis against bacterial infections. And the recommendation is still with the fluoroquinolone. And that's recommended for most patients who are at high risk for febrile neutropenia or profound, really prolonged neutropenia, such as those getting therapy for AML, or myelodysplastic syndrome, or stem cell transplant recipients, particularly with myeloablative regimens. In the lower risk groups, such as those with most solid tumors, fluoroquinolone prophylaxis is not recommend. In terms of antifungal prophylaxis, what is recommended is an oral triazole or Micafungin-- for patients, again, at risk for profound protracted neutropenia such as that AML, MDS, stem cell transplant group during that period of neutropenia. When the risk of invasive aspergillus is high, such as in patients with AML or MDS during the neutropenia period while getting chemotherapy, then the consideration of a mold-active triazole is recommended and in addition should be considered in the context of stem cell transplant recipients with graft versus host disease. In terms of PCP prophylaxis, PCP preventive therapies are recommended for those at high risk for PCP, which include those on greater than what we say 20 milligrams of prednisone equivalent a day for over a month, or based on purine analog use. Viral prophylaxis for HSV is recommended for seropositive patients undergoing allogeneic stem cell transplant or leukemia induction. And then as I mentioned before, patients at risk for hepatitis B reactivation are recommended treatment with a nucleoside reverse transcriptase inhibitor. And this is more carefully discussed in the ASCO Provisional Clinical Opinion on Hepatitis-B Virus Screening for Patients With Cancer Before Therapy. It's also recommended that a yearly flu vaccine is given to patients as well as given to family, household contacts, and health care workers. Other vaccination recommendations are as per the Infectious Disease Society of America Guidelines for Vaccination of Immunocompromised Hosts. And then the other things that are recommended are really review and repeat recommendation of adherence with hand hygiene, with respiratory etiquette, which is recommended and really required for all health care workers. And that out patients with neutropenia from cancer chemotherapy should avoid high risk activities, which include really contact with environments that have high concentration of fungal spores such as construction and demolition, high intensity gardening, et cetera. So those are really a summary of the key recommendations of this guideline. And finally, how will these guideline recommendations affect patients? I think it's important to remember that to ensure best practices on infection prevention, the literature needs to be reviewed frequently and guidelines need to be updated. I don't think that these current guidelines will dramatically change the preventive strategies that are used for patients, with the exception of perhaps a few extra vaccines-- some newer indications for pneumocystis prevention, hepatitis B reactivation prevention, those kinds of things. However, I think in reviewing the literature, it becomes clear what will we will need to be thinking about in the coming years, what we will need to be assessing. And a couple of those things are the dramatic increase in the use of immune-based therapies and how that will affect infection risk in patients with or without neutropenia. We need to be considering the effects of routine antibiotic prophylaxis on the microbiome and the risks that that might incur. And we need to really understand how new vaccines can be utilized. So yeah, I think these areas are really ripe for research and need to be followed closely to ensure optimization of these preventive strategies for our patients in the future. Thank you for your time today, Dr. Taplitz. You're quite welcome. And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. If you've enjoyed what you heard today, please rate and review the podcast and refer this show to a colleague.

SUPPORT OUR SPONSOR:  http://www.naturebox.com/thinkingatheistDr. Paul Offit is Director of the Vaccine Education Center at the Children's Hospital of Philadelphia, as well as the Maurice R. Hilleman Professor of Vaccinology, and a Professor of Pediatrics at the Perleman School of Medicine at the University of Pennsylvania.  He has received awards for his work from the University of Maryland, the Infectious Disease Society of America, the National Institutes of Health, the American Academy of Pediatrics, and more, and he was elected to the Institute of Medicine of the National Academy of Sciences in 2011.  An author of over 150 scientific papers, Dr. Offit is the co-inventor of the rotavirus vaccine, "Rotateq," and he released the book, "Bad Faith: When Religious Belief Undermines Modern Medicine," which was selected as an Editor's Choice by the New York Times in 2015.In this 2nd half of our "Medical Neglect" show, Dr. Offit speaks with Seth Andrews about faith, medicine, belief, and faith-based ideas which often harm those who embrace them.