Podcasts about pneumocystis

Dr. Patimavirujh, A PGY-2 resident at the USF Morsani College of Medicine, reviews the use of steroid medication in the management of infectious diseases syndromes. Following an introduction on the history of steroids in medicine, the speaker compares and contrasts steroid agents with mineralcorticoid and glucocorticoid activity. Next, the pharmacokinetics of steroids are discussed, as well as dose equivalencies for the different steroid molecules. Next, the use of steroids for various infectious diseases are discussed, including for pneumonia (including Pneumocystis infection), bacterial meningitis, TB meningitis, and cryptococcal meningitis.

On episode #77 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 3/13/25 – 3/26/25. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Food is medicine for human immunodeficiency virus: improved health and hospitalizations in the changing health through food support (chefs-hiv) pragmatic randomized trial (JID) The epidemiology and burden of human parainfluenza virus hospitalizations in u.s. children (Journal of the Pediatric Infectious Diseases Society) Bacterial Epidemiology and outcomes of bloodstream infections in patients in a burns intensive care unit: an eight-year retrospective study(OFID) Prophylactic vancomycin in the primary prevention of clostridium difficile in allogeneic stem cell transplant(Transplant Infectious Disease) Incidence of scrub typhus in rural south India (NEJM) Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections(NEJM) Blood Culture–Negative Endocarditis(Journal of the American Heart Association) Brucella suis Infection in Cardiac Implantable Device of Man Exposed to Feral Swine Meat, Florida, USA (CDC Emerging Infectious Diseases) Hyperbilirubinemia at hospitalization predicts nosocomial infection in decompensated cirrhosis (Hepatology Communicatons) Fungal The Last of US Season 2 (YouTube) Fungal Infections in People Who Use Drugs (OFID) IDSA 2025 guideline update on the treatment of asymptomatic histoplasma pulmonary nodules (histoplasmomas) and mild or moderate acute pulmonary histoplasmosis in adults, children, and pregnant people(IDSA: Infectisous Disease Society of America) Changing trends in the sources and volumes of clinical cultures with Candida auris at a large health system, 2019-2023 (American Journal of Infection Control) Diagnostic test accuracy of the Fungitell serum (1→3)-β-D-glucan assay for the diagnosis of Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis (CMI: Clinical Microbiology and Infection) Parasitic Impact of Strongyloides stercoralis Coinfection on Disease Severity and Treatment Outcomes in Pulmonary Tuberculosis (OFID) Hematology thin smears perform equally to parasitology thick and thin blood smears for the diagnosis of Plasmodium and Babesia infections in a low prevalence setting (Journal of Clinical Microbiology) Notes from the Field: Rhodesiense Human African Trypanosomiasis (Sleeping Sickness) in a Traveler Returning from Zimbabwe — United States, August 2024 (CDC: MMWR) Miscellaneous The history of phage therapy LANCET: Infectious Diseases) Silence=death redux: infectious diseases, public health, and the imperative to resist (CID) Silence = Death, 1990(David Wojnarowicz Foundation) SILENCE=DEATH (B200KLYN Museaum) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

Dr. Rod Quilitz, infectious diseases pharmacotherapist at the Moffitt Cancer Center and Research Institute, presents his talk regarding the infectious diseases syndromes likely to be encountered when managing ID complications in an immunocompromised population. Dr. Quilitz begins by discussing risk factors for infection. He then goes on to discuss neutropenic fever management. The contrast between low grade and high grade neutropenia is also differentiated. Next, Dr. Quilitz discusses strategies for prophylaxis of patients who have prolonged neutropenia, including the use of gram positive antimicrobial agents and antifungals. Other subjects covered include the spectrum of CART toxicities, immune reconstitution, prophylaxis for Pneumocystis, CMV disease/prophylaxis, and other viral infections in the immunocompromised population.

On episode #73 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 1/16/25 – 1/29/25. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral AGA clinical practice guideline on the prevention and treatment of hepatitis B virus reactivation (Gastroenterology) Host-microbe multiomic profiling identifies distinct COVID-19 immune dysregulation in solid organ transplant recipients (Nature Communications) Insect-specific RNA viruses detection in Field-Caught Aedes aegypti mosquitoes from Argentina using NGS technology (PLoS Neglected Tropical Diseases) Bacterial Oral regimens for rifampin-resistant, fluoroquinolone-susceptible tuberculosis (NEJM) Impact of antibiotic treatment and predictors for subsequent infections in multidrug-resistant Pseudomonas aeruginosa catheter-associated asymptomatic bacteriuria (American Journal of Infection Control) Identification of the skip phenomenon among patients With Staphylococcus lugdunensis infective endocarditis (OFID) Emergence of infective endocarditis due to Serratia spp. (OFID) Reduction of vancomycin-associated acute kidney injury with montelukast (JID) Fungal The Last of US Season 2 (YouTube) Pulmonary co-infection of Pneumocystis jirovecii and Aspergillus species (OFID) Impact of fluconazoleon outcomes of patients with primary pulmonary coccidioidomycosis (CID) Parasitic Comparative outcomes of Babesiosis in immunocompromised and non-immunocompromised hosts (CID) Miscellaneous Hidradenitis suppurativa (LANCET) A severe case associated with mixed infections of Pasteurella multocida, Bacteroides pyogenes and Fusobacterium necrophorum due to a snow leopard bite (CMI: Clinical Microbiology and Infection) INSIDE-OUT: Introduction of speakers at IDWeek events (OFID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

On episode #71 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 12/19/24 – 1/1/25. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Routine detection of viruses through metagenomics: where do we stand? (ASTMH) Rapid selection of HIV-2 capsid mutations in salvage therapy with Lenacapavir-containing regime (CID) Bacterial Ancient genomes reveal a deep history of treponemal disease in the Americas (Nature) The utility of Interferon-γ release assays in the diagnosis of tuberculosis in patients With cancer(Transplant Infectious Disease) A meta-analysis of Levofloxacin for contacts of multidrug-resistant tuberculosis (NEJM Evidence) Tularemia— United States, 2011–2022 (CDC: MMWR) Incorporating incubation period distributions to precisely estimate the association between rainfall and Legionella infection (JID) Fungal The Last of US Season 2 (YouTube) Candida albicans recovered from persistent candidemia exhibit enhanced virulence traits (JID) Mapping the geographic distribution of dimorphic mycoses using a U.S. commercial insurance database (OFID) Comparative efficacy and safety of treatment regimens for Pneumocystis jirovecii pneumonia in people living with HIV – A systematic review and network meta-analysis of randomized controlled trials (CMI: Clinical Microbiology and Infection) Outbreak of Blastomycosis Among Paper Mill Workers — Michigan, November 2022–May 2023 (CDC: MMWR) Parasitic Acanthamoeba Infection in a hematopoietic cell transplant recipient: challenges in diagnosis, management, and source identification (Transplant Infectious Disease) Congenital toxoplasmosis: Fewer clinical signs at 3 years of age over the last 15 years but stable risk of materno-fetal transmission (CID) Miscellaneous Detection of prions in wild pigs (Sus scrofa) from areas with reported chronic wasting disease cases, United States (CDC Emerging Infectious Diseases) Addition of macrolide antibiotics for hospital treatment of community-acquired pneumonia (JID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Cardiovascular Events During Pregnancy: Implications for Adverse Pregnancy Outcomes in Individuals With Autoimmune and Rheumatic Diseases - doi.org/10.3899/jrheum.2024-0306 Canadian Rheumatology Association/Spondyloarthritis Research Consortium of Canada Living Treatment Recommendations for the Management of Axial Spondyloarthritis - doi.org/10.3899/jrheum.2023-1237 Incidence of Pneumocystis jirovecii Pneumonia and Prophylaxis-Associated Adverse Events Among Patients With Systemic Lupus Erythematosus - doi.org/10.3899/jrheum.2023-1038 Epidemiological characteristics of patients with juvenile dermatomyositis in China: a multicenter study - doi.org/10.3899/jrheum.2024-0003 Knowledge of and Stated Adherence to the 2020 ACR Guideline for Gout Management: Results of a Survey of US Rheumatologists - doi.org/10.3899/jrheum.2023-0981

Dr Cilia Nazef, Infectious diseases Fellow at the University of South Florida Morsani College of Medicine, explores how Pneumocystis jirovecii, a fungal infection typically affecting immunocompromised patients, can also affect patients suffering from hypercortisolism. Dr. Nazef begins by examining different cases of Pneumocystis jirovecii Pneumonia (PJP) in patients with Cushings disease. Next, she further explains the immunologic basis behind how the hypercortisol state induces immunosuppression. Dr. Nazef closes by examining the basis for PJP prophylaxis in Cushings disease patients, and the shortcomings of the current literature in advocating prophylaxis options.

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Pneumocystis jirovecii Pneumonia (PCP)⁠ ⁠from the Infectious Disease section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

Dr Guy Handley, Assistant Professor of Medicine at the Division of Infectious Diseases, Morsani College of Medicine, discusses the Clinical manifestations of Pneumocystis Jirovecii infections in a question and answer format. Dr. Handley begins the talk by giving an overview of Pneumocystis, including its history and taxonomy. He then discusses the typical presentation when it causes pneumonia (PCP), the most likely clinical manifestation. Dr. Handley then covers PCP treatment, including the most commonly used therapy (trimethoprim-sulfamethoxasole) and other alternatives. Next, diagnostic testing is discussed, including the use of the 1,3 Beta-Gucan test. Lastly, the use of Echinocandins for the treatment of PCP pneumonia is covered.

On episode #48 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 1/31 – 2/13/24. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Infectious attenuated tetravalent Butanatan-Dengue vaccine (NEJM) Kids with severe disease following first and second dengue virus infection (Nature) Oropouche fever outbreak in Latin America (Lancet Infectious Diseases) CMV mRNA vaccine knocks out gB/MF59 vaccine (JID) Acyuclovir-resistant mucocutaneous HSV in immunocompromised patients (OFID) Bacterial Dalbavancin for vertebral osteomyelitis (OFID) Severe vibrio vulnificus infections (MMWR) Demystifying UTIs in the era of antibiotic resistance (PLoS Pathogens) Syphilis testing recommendations (MMWR) Doxycycline vs azithromycin for scrub typhus (BMC Infectious Diseases) REALLY drug resistant Pseudomonas aeruginosa outbreak(CID) Fungal SUBA or conventional itraconazole for treatment of endemic mycoses (OFID) Fluconazole resistant Candida (CDC) Are you in the hospital too long after being treated with echinocandin for your Candidemia or invasive Candidiasis (OFID) Nasopharyngeal swab or lower respiratory tract specimen for Pneumocystis jirovecii diagnosis (OFID) Global guideline for cryptococcosis diagnosis and management (Lancet Infectious Disease) Parasitic Toxoplasma IgG positivity associates with increase mortality (AJTMH) Miscellaneous How well did infectious diseases fellows match (JID) Back to the future of the physician-scientist in infectious diseases (JID) Full or not infectious disease training (JID) Music is by Ronald Jenkees

“I collect spores, molds and fungus” - Dr. Egon Spengler Dr. Ilan Schwartz MD PhD (@GermHunterMD) teaches us that we should always at least consider fungi in the differential diagnosis of unexplained sepsis, especially in patients with impaired immune systems or complex medical or surgical histories, and walks us through an approach to antifungals.  Be sure to check out the Mycoses Study Group Education & Research Consortium (@MSG_ERC), an organization of clinicians who are dedicated to advancing diagnostics and treatment of fungal disease (where Dr. Schwartz serves on the board of directors!) Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Rapid fire questions, get to know our guest Intentionally vague case; When should we be worried about fungal infection? Overnight emergencies: Candidiasis and mucormycosis Starting empiric anti-fungals Testing basics: direct versus indirect Fungemia, fungal endocarditis Resistant candida; candida auris Pneumocystis jiroveci pneumonia Outro Credits Producer, Writer, Show Notes, Infographic/Cover Art: Beth Garbitelli MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Garbitelli MD Reviewer: Emi Okamoto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Ilan Schwartz MD, PhD Sponsor: Uncommon Goods To get 15% off your next gift, go to uncommongoods.com/CURB. Sponsor: NetSuite Go to NetSuite.com/CURBSIDERS to get your own KPI Checklist.  Sponsor: Locumstory Get a comprehensive view of locums at locumstory.com.

Episode Notes In what has been described on Twitter as the “doing your own taxes of medicine,” Drs. Emily Heil (@emilylheil) and Andrew Fratoni (@AFratty) join Dr. Jillian Hayes (@thejillianhayes) to break down the ins and outs of sulfamethoxazole/trimethoprim dosing! Tune in for a discussion on the use of this agent for methicillin-resistant Staphylococcus aureus, gram-negatives, pneumocystis, and Stenotrophomonas maltophilia. References: Twitter Thread re: Bactrim dosing: https://twitter.com/IDdocAdi/status/1661174505702674432?s=20 PJP OI Guidelines: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/pneumocystis-0 IDSA Resistant Gram Negative Guidance Document: https://www.idsociety.org/globalassets/idsa/practice-guidelines/amr-guidance/1.0/idsa-amr-guidance-v3.0.pdf (Lower doses of PJP Treatment): Butler-Laporte G, Smyth E, Amar-Zifkin A, Cheng M, McDonald E, Lee T. Low-dose TMP-SMX in the Treatment of Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-Analysis. Open Forum Infectious Diseases, Volume 7, Issue 5, May 2020, ofaa112, https://doi-org.proxy-hs.researchport.umd.edu/10.1093/ofid/ofaa112 (DS Vs SS for PJP PPX): Schneider MM, Nielsen TL, Nelsing S, et al. Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. Dutch AIDS Treatment Group. J Infect Dis. 1995;171(6):1632-1636. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7769306. General Bactrim PK/PD: Trubiano JA, Grayson ML. Trimethoprim and Trimethoprim-Sulfamethoxazole (Cotrimoxazole). Chapter 92, Kucers' The Use of Antibiotics (7th Edition). Taylor & Francis, 2017. (2014 IDSA SSTI Guidelines). PMID 24973422 Cadena J, Nair S, Henao-Martinez AF, Jorgensen JH, Patterson JE, Sreeramoju PV. Dose of trimethoprim-sulfamethoxazole to treat skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2011 Dec;55(12):5430-2. doi: 10.1128/AAC.00706-11. Epub 2011 Sep 19. PMID: 21930870; PMCID: PMC3232808. Halilovic J, Heintz BH, Brown J. Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. J Infect. 2012 Aug;65(2):128-34. doi: 10.1016/j.jinf.2012.03.013. Epub 2012 Mar 21. PMID: 22445732. Paul M, Bishara J, Yahav D, Goldberg E, Neuberger A, Ghanem-Zoubi N, Dickstein Y, Nseir W, Dan M, Leibovici L. Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial. BMJ. 2015 May 14;350:h2219. doi: 10.1136/bmj.h2219. PMID: 25977146; PMCID: PMC4431679. Lasko MJ, Gethers ML, Tabor-Rennie JL, Nicolau DP, Kuti JL. In Vitro Time-Kill Studies of Trimethoprim/Sulfamethoxazole against Stenotrophomonas maltophilia versus Escherichia coli Using Cation-Adjusted Mueller-Hinton Broth and ISO-Sensitest Broth. Antimicrob Agents Chemother. 2022 Mar 15;66(3):e0216721. doi: 10.1128/aac.02167-21. Epub 2022 Jan 10. PMID: 35007135; PMCID: PMC8923228. Lasko MJ, Tabor-Rennie JL, Nicolau DP, Kuti JL. Trimethoprim/sulfamethoxazole pharmacodynamics against Stenotrophomonas maltophilia in the in vitro chemostat model. J Antimicrob Chemother. 2022 Oct 28;77(11):3187-3193. doi: 10.1093/jac/dkac304. PMID: 36101486. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Welcome to the party pal! The penicillin allergy assessment and delabelling party, that is. Callum takes Jame through the latest evidence base in antibiotic allergy in general, and beta lactam allergy assessment and management in particular. Links: PENFAST Score paper: Trubiano JA et al. Development and Validation of a Penicillin Allergy Clinical Decision Rule. doi: 10.1001/jamainternmed.2020.0403.Sulfonamide allergy paper here (couldn't find anything published more recently): Urbancic KF et al. Taking the challenge: A protocolized approach to optimize Pneumocystis pneumonia prophylaxis in renal transplant recipients. doi:10.1111/ajt.14498Dutch beta lactam allergy guidelines: https://swab.nl/en/exec/file/download/192And finally...Norvell MR et al. Cefazolin vs. second-line antibiotics for surgical site infection prevention after total joint arthroplasty among patients with a beta-lactam allergy. https://doi.org/10.1093/ofid/ofad224Yippee Ki-Yay, my delabellers, we'll see you in a fortnight. Support the showQuestions, comments, suggestions to idiotspodcasting@gmail.com or Tweet us @IDiots_podPrep notes for completed episodes can be found here: https://1drv.ms/u/s!AsaWoPQ9qJLShugmB2EOm8FMePNBtA?e=IKApb5If you are enjoying the podcast please leave a review on your preferred podcast app!Feel like giving back? Donations of caffeine gratefully received!https://www.buymeacoffee.com/idiotspod

On episode #26 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the previous two weeks, 3/30 – 4/12/23. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Fatal rabies infection with failure of post-exposure prophylaxis following a zoonotic exposure (CID) Bivalent perfusion F vaccine in pregnancy to prevent RSV in infants (NEJM) Adeno-associated virus type 2 in US children with severe hepatitis (Nature) Genomic investigations of unexplained hepatitis in children (Nature) Antiretroviral treatment of HIV/AIDS during pregnancy (JAMA) Rapid PCR for respiratory viruses reduces time to result and improves clinical care (JOI) Postexposure doxycycline to prevent bacterial sexually transmitted infection (NEJM) Survey on antimicrobial resistance genes of used probiotic bacteria (EURO) Structured immune work-up in healthy children with episode of severe bacterial infection (JID) Antibiotic prescribing in U.S. nursing homes (JID) Syndromic panel testing among patients with infectious diarrhea (OFID)  Early predictors of infected pancreatic necrosis in severe pancreatitis (DD) Management of nontuberculous mycobacteria in lung transplant cases (ERJ) Impact of extended-infusion piperacillin-tazobactam (Infectious Medicine) Camber Pharmaceuticals issues nationwide recall of atovaquone oral suspension due to potential Bacillus cereus contamination (FDA) Cluster of Blastomycosis among neighborhood residents (CDC) Risk factors for late-onset Pneumocystis jirovecii pneumonia in liver transplant recipients (IJID) Hyponatremia predicts cryptococcal meningitis and mortality in HIV-Positive asymptomatic individuals with cryptococcal antigenemia (OFID) Investigation of donor-derived Strongyloides stercoralis infection in multiple solid organ transplant recipients (TID) Promising new malaria vaccine for kids approved in Ghana (AP) Music is by Ronald Jenkees

Listen to ASCO's Journal of Clinical Oncology essay, “First Cousins Once Removed” by Dr. Matthew Farrell, a radiation oncology resident at UCLA. The essay is followed by an interview with Farrell and host Dr. Lidia Schapira. Farrell paints scenes of how different family dynamics can come into play when advocating for patients. TRANSCRIPT Narrator: First Cousin Once Removed, by Matthew J. Farrell, MD, MFA (10.1200/JCO.22.02611)  When I was a kid, long before I wanted to be a doctor or had even heard of oncology, I dreamed of becoming an actor. I grew up in Sacramento—not exactly the beating heart of the film industry—but my mother's mother lived in Santa Monica and we would stay with her for a month every summer. My father would unashamedly sneak me into movie premieres in famous theaters, and he bought us season passes to Universal Studios Hollywood. Despite having a serious job—as a psychologist in the emergency department—he was a kid at heart. Los Angeles was our promised land, and our shepherd was my father's cousin John, my first cousin once removed, who lived in West Hollywood and was a living, breathing actor.  John wasn't famous, not yet. He was in his late 20s, just starting out, doing mostly background work and some commercials while working as a waiter at the original Cheesecake Factory in Beverly Hills. All the staff loved him there, so much so that they would give us free pieces of cheesecake just for being related to him. John was generous, outgoing, expressive, and talented. Success seemed just around the corner.  One challenge for him was his voice. He had a thick Bronx accent, which would have been perfect if he had been auditioning for Raging Bull but which otherwise narrowed his prospects. He hired a voice coach to help him erase his accent. But that didn't mean he was trying to erase his New York roots. He was proud of his upbringing and family, coming from a long line of police officers, burly men with strong jaws and thick arms and outdoor voices who seemed to be the very genesis of their own stereotype. And as his Bronx accent faded, he was teaching it to me. He said he would take me to a baseball game at Yankee Stadium one day, and he imitated the beer hawkers who walked up and down the aisles, calling out to the crowd, “Get your beer here,” but pronounced, “Getcha bee-ah hee-ah!” John was the first person I distinctly remember being in perfect shape. He was a sight to behold—muscular and solid, yet graceful and light on his feet. In addition to being an actor, he was training as a dancer. Coming from generational athletic ineptitude myself, I was enthralled. He taught me how to moonwalk and do bicep curls. I would walk up to my mother and flex my tiny muscles, imagining a day when I would be as strong as John. One summer, John was much thinner—his face hollowed out, his previously bulky arms as lean as my own. What I only vaguely understood at the time was that he was gay, and he now had AIDS. This was the mid-1990s, and highly active antiretroviral therapy was on the horizon but just out of reach.1,2 His treatments failing him, he became desperate for a cure. He did twice daily coffee enemas, choked down repulsive herbal concoctions, and visited New Age visionary healers. For a long time, he remained optimistic. He was in constant contact with his agent, seeking out auditions even as his strength waned. He wasn't only a waiter at The Cheesecake Factory and he wasn't dying of AIDS; he was an actor who was going to be healthy again soon. Occasionally he would call my dad, buoyant with hope, “The virus is gone. I'm cured.”  Of course, he wasn't. My father never tried to talk John out of pursuing alternative therapies, though he considered doing so many times. The frantic search for a reprieve from death can take us many places, and it is not to be pitied. But how do you also protect your loved ones from harmful remedies and predatory scam artists? How do you provide the best treatment when there is no good treatment? In all my years, all 10 of them, I had thought that doctors knew everything, and if you went to them, you would get better. But John wasn't getting better. Together with his doctors, we embraced helplessness.  His CD4 count fell to zero. He developed skin lesions from Kaposi sarcoma. He was repeatedly hospitalized with Pneumocystis pneumonia. His organs began failing. Ultimately, he decided to leave the hospital on hospice. It was only then that he told his parents he was gay and had AIDS. At first, his parents couldn't believe he was gay. They told my father it was a phase, possibly brought on by his living in Los Angeles, a side effect of being an actor and dancer. Later, at his memorial service in New York, they would tell everyone he had died of a rare cancer. My father remembers someone asking John's mother what kind of cancer it was, and she said, “I don't know. It's very rare.”  During my winter break from school, my family visited John in his apartment. By that time, he had needed to quit his job at The Cheesecake Factory and stop taking auditions. His friends at the restaurant had thrown him a party and still came by his apartment most days. He lay in bed, drowsy and mildly delirious, too weak to stand. Even in this state, he kept trying to sit up to get us something to eat or drink. “I have cheesecake,” he said several times. “Let me get you some cheesecake.” Just a week later, on the day after Christmas, John lost consciousness. His kidneys weren't making urine, and he was uremic. My father urgently updated John's family in New York. His mother, father, and three sisters with their husbands flew in that day and crowded into John's small West Hollywood apartment.  For the first time, they met John's partner, Kevin, and five of their friends, gay men who had taken turns caring for John to make sure he was comfortable and never alone. Kevin was tall, elegant, and gentle. He was as introverted as John was extroverted, and he wouldn't have been caught dead on stage in front of an audience. He ran his own successful small business and had a quiet self possession. John, though he rarely showed it, was insecure about his slow progress in the acting world, and I think Kevin helped him feel more at ease. As a medical professional and the closest relative on the West Coast, my father had served as the point person for the hospice physician. He reported the latest news: John likely had just hours to live. John's New York family, previously shielded by distance, was caught off guard. And there was an uproar. The five stages of grief multiplied to 25, occurring in no discernible order—undulations of shouting and crying and jostling that rolled through the group like The Wave through a baseball crowd. At first, they wanted to take him off hospice. They looked ready to carry him out the door to the nearest hospital. They said his decline was too sudden. It just wasn't right. There must be something he hadn't tried. For every desperate hope they volleyed, my father sensitively explained what could and could not be done, and, more importantly, he described John's wishes. They gradually realized that saving him was impossible, and not what John needed anymore. At last, everyone seemed on the same page. Everyone but John. Day by day, he held on in his unconscious state, not crossing that final threshold, as if something were holding him back. John's family became increasingly exhausted, confused, and frustrated. They couldn't eat or sleep. On day four of John's marathon survival, we called in the hospice nurse. By this time, my grandfather—John's uncle— had also arrived. The nurse gathered everyone together and explained that it was often helpful to talk to your loved one, conscious or not, to say goodbye. People who are dying may feel obligated to cling to life for their family's sake. They may need our permission, even our encouragement, to let go.  And so, one by one, we all entered John's bedroom, knelt beside him, and said what we needed to say. And then, it was my grandfather's turn. By way of introduction, Grandpa Joe, my father's father, was raised in the Bronx by a stern mother and career soldier father. He was a businessman by profession and by religion. He rose in the ranks of multiple companies, eventually becoming the president of Hires Root Beer, a company that expanded during his tenure but was eventually bought by Orange Crush, which in turn crushed Hires Root Beer and made a lifelong enemy of my grandfather. (In my family, we do not drink Orange Crush.) Grandpa Joe never surrendered without a fight.  Accompanied by my father and me, Grandpa Joe marched up to John's bed and bent down beside him.  “You can fight this!” he said, shaking his fist. “I've had illnesses all my life and I came out on the other side. Did I let prostate cancer beat me? Hell no!” “Wait, Dad,” my father said. “Wrong plan.” “What?” Grandpa Joe said. “We had a whole conversation about this.” “When?” “Just now, with the hospice nurse. We need to let go, allow John to pass on.” “That's not what I heard.” “That's becoming clear to me.”  My father reviewed the plan, slowly, but no matter how well you explain yourself, sometimes people hear only what they're capable of hearing. Grandpa Joe couldn't surrender. He argued and fumed, eventually stormed out. So my father said goodbye for him. That night, John died.  I doubt the timing of his death was related to our collective send-off, but it sure felt like it was, and that will do. The next day, everyone assembled in John's apartment for the last time to decide what to do with his body. The family wanted to take him back to New York for a traditional burial.  But there had been talk that John's Los Angeles friends were planning to have him cremated. As if about to face off, two groups formed in opposing semicircles of folding chairs—the family seated on one side, and Kevin and his friends on the other. John's father, Hank, seemed ready to fight, his whole family there to back him up. Grandpa Joe kept saying we needed to put John on a plane and get him out of there.  In medical school, we learn that not all family members are created equal; when patients can't make decisions for themselves and there is no living will, you turn to the spouse first, adult children next, then parents, and so on. There is even a mnemonic (one of the clunkiest in existence) to help you remember the ranking: the Spouse ChiPS in For the patient—indicating Spouse, Child, Parent, Sibling, and Friend, in that order. Following this rule, Kevin would have come last. He and John weren't married, and gay marriage wasn't even legal then. My father, a child of the sixties, wasn't a fan of hierarchies. As a psychologist in the emergency department, he had always strived to foster a unanimous meeting of the minds and hearts. To make things a little easier on people like him, he says it is never too early to tell anyone and everyone what you want in life and in death. Then, importantly, write it down, in an advance directive, on a POLST form, and maybe even on a few napkins scattered throughout the house. Hank fired the opening salvo: he told Kevin that they were going to take John back to New York. Their community expected a traditional burial, needed it.  Kevin listened quietly until Hank finished. With a softspoken grace, he looked Hank in the eyes and told him he would never do anything against the family's wishes. If they wanted a burial in New York, he would help carry the casket. But, he said, John had told him many times that he wanted to be cremated and have his ashes scattered on Maui, at a certain overlook they had visited together. There was a long silence. Hank looked around, at his wife and family, at Grandpa Joe, all of whom seemed to be waiting for him to deliver their counterpunch. But then he lowered his head. He started crying into his hands.  A minute passed, and then he sat upright, sniffed, and nodded. In a clear, firm voice, he said, “That's it. That's what I want for John. I want you to take him to Maui.” In perhaps the only true miracle I have ever personally witnessed, Kevin and his friends lifted from their chairs in perfect unison, crossed the small living room, and flooded the family with hugs. Everybody cried, and the many headed beast of our congregation dissolved into a sea of affection. Kevin did go to Maui to scatter John's ashes. Afterward, John's family celebrated his life with a memorial service at their church in New York. My father gave the eulogy and Kevin sat with the family. All of this was a long time ago now. John would be in his fifties. He would have mastered a Hollywood accent. His big break would have come. He would have taken me to the Oscars. I moved away from California to go to graduate school and medical school, but eventually, I found my way back to Los Angeles. I still go to iconic theaters. I finally bought season passes to Universal Studios Hollywood. And like everyone else in this town, I'm trying to write a screenplay. But I'm not an actor. I'm not remotely famous. I'm a radiation oncology resident.  I've learned a few things since the 1990s, and so has the rest of the world. It still devastates me that John just missed the major advances in care. I think about him regularly during my training. In oncology, life-prolonging breakthroughs are frequent, which inevitably means that some people will be among the last to miss out. Some people, and their families, will look to me for hope when there is none. In their entreaties, I see shades of my own loved ones—my father's diplomacy, Grandpa Joe's doggedness, Kevin's advocacy, Hank's compromise. Most of all, I see glimmers— brief resurrections—of John, whose disease stripped away so much, but left in clear relief his kindness and humanity.  Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lydia Schapira, Associate Editor for Art of Oncology and a professor of medicine at Stanford University. Today we're joined by Dr. Matthew Farrell, a radiation oncology resident at UCLA. In this episode, we will be discussing his Art of Oncology article ‘First Cousin Once Removed'. At the time of this recording, our guest has no disclosures.   Matt, welcome to our podcast, and thank you for joining us. Dr. Matthew Farrell: Thank you so much for having me. Great to be here. Dr. Lidia Schapira: It's our pleasure. I'd like to start this conversation just asking a little bit about your reading preferences. Are there any books that are on your figurative night table right now that you'd like to recommend to our listeners?  Dr. Matthew Farrell: Yeah, a lot of times that night table is very figurative in that I am listening to audiobooks. Living in LA, I spend a lot of time in the car, so I listen to a lot of books. But I do like to physically read certain books, and one of those recently was George Saunders' new collection of short stories, Liberation Day. He is a wonderfully creative, funny, warm-hearted writer of short stories, which is one of my favorite forms. It's what I've written the most and what I studied the most back when I was in school, taking classes, undergraduate and graduate in creative writing.  Dr. Lidia Schapira: Tell us a little bit about your passion for writing and how you have integrated that into your professional life now as a medical oncologist?  Dr. Matthew Farrell: Yeah, I studied writing and was interested in writing before I transitioned to medicine. So, I minored in creative writing in college, and then I went to graduate school to get a Master of Fine Arts in creative writing and fiction writing. And it was partially that process that eventually led me into medicine. I realized that a lot of what I was writing about actually had to do with medicine. And as I was rereading some of my own work, I was drawn to stories of illness and family and recovery and processing grief, and I decided that those stories were really compelling to me and decided to transition to medicine. It was also helpful that my wife - girlfriend at the time - was applying to med school, so I had that idea in my head, and she was inspiring to me. So, I transitioned to medicine.I love to keep writing. I still love writing, and a lot of what drew me into oncology specifically is the brilliant, captivating, moving stories of interacting with people. And so it's one of my outlets and things I do for fun, as well as a way of helping me process what I see.  Dr. Lidia Schapira: Before we talk about this story, let's talk a little bit about your ideas of the language that we use, because I know you've written about that as well. So, as a writer and as a person who loves to reflect and find story, tell us a little bit about how you negotiate the words you use and the language you hear your colleagues and your peers using with patients.  Dr. Matthew Farrell: Coming from a writing background, where in workshop, we would go through our own stories, my writing professors would go through each word with a fine-toothed comb and sometimes in very elaborately, critical ways would say that this is a terrible word, this destroys the whole sentence, the whole story. And it just had me paying attention to the written language as well as the spoken language. And one of my creative writing mentors, my thesis advisor Ahud, he had leukemia and eventually died of leukemia, and he talked a lot about the experience of having cancer and the way that cancer is often talked about in this kind of heroic way in which the treatments are weapons and cancer is waged on a battlefield and people with cancer are heroes of that and how that can be very empowering in certain circumstances and also very draining in others. Dr. Lidia Schapira: Those are such fine points, and it's obvious that you're very careful about the language that you use in your writing. So, let's talk a little bit about this piece that we've just published in JCO that is a little different than most of the pieces because it describes scenes. Tell us about how you put these scenes together, what it meant to you, and what the overarching message is for your readers.  Dr. Matthew Farrell: Yeah, I think I'm used to writing scenes. I'm used to writing both fiction and nonfiction stories like this, and when I was approaching this, I just wanted to try to capture the experiences as I had understood them. And I also talked a lot with my family about them to try to remember what it was like and how our thoughts have changed on it over time. And so I tried to capture who John was and my memories of him as best as I could. I think that the best way to get across people's personalities, their vibrancy, is by writing scenes about them, because I can never describe someone as well as they can illustrate themselves through their own actions and dialogue. Dr. Lidia Schapira: So John was this figure that you had admired as a child and was so interesting, and then you bring us to a very debilitated John and some scenes in his apartment. Tell us a little bit about the time, the context, and the illness.  Dr. Matthew Farrell: Sure. This was the mid-1990s, and there were a lot of changes going on in the care of HIV and AIDS, a lot of rapid changes in our understanding of the illness as well as the treatments available for it. And it was really hard and devastating that John was able to see a lot of promising treatments on the horizon, but they weren't readily available to him when he needed them. And so it's tragic to think about, if all of this had happened just a year later with the rollout of HAART, or Highly Active Antiretroviral Therapy, his story might have been completely different, and he could easily still be here today, but he just missed it. And so that was very hard to see him go from being just about as vibrant and healthy and active a person as can be imagined, someone who I just envied and admired in terms of his physical ability; for him, if he could go from where he was to where he ended up, it was just completely devastating. Dr. Lidia Schapira: And then there was the stigma of the disease and the scene that you so beautifully share in your piece about different family members coming in to talk with him and say their goodbyes. And I think it was your grandfather who just couldn't let go of the ‘you must fight, you're going to get well' narrative. And I think your father, who is a psychologist, was sort of saying, "Hey, wait, we're having the wrong conversation here. This isn't what we agreed to." Can you tell us a little bit about what that felt like to you, observing it, perhaps your younger self and how you've thought about that now as a professional who's probably having these difficult conversations with patients?  Dr. Lidia Schapira: This was my first experience with these sorts of conversations, and I think about them a lot now, is I do have these talks with people, and I just can picture my Grandpa Joe charging in there and saying, "You can fight this," completely out of tune with what the goal was. And he and my father are similar in some ways, but very different in others. My father is very relaxed, easy-going. He could come to a cordial agreement with a grizzly bear, and my grandfather was that grizzly bear in some respects, and he was stubborn and not always the best listener. But what was striking about it to me is that I know that my grandfather's actions in that moment, even though they weren't in line with what we were trying to do or what my father and the hospice folks were trying to have us do, they still came out of love and out of devotion to John. Grandpa Joe, how he expressed his love for his family was through fighting for them, and so he was doing that for John in the only way that he knew.  And so when I am involved in conversations toward the end of life with goals of care now and I see situations in which people don't always reach the same page or come to the same understanding, I'm reminded of the fact that that can be surprising and frustrating, but it's okay because people process grief in their own ways and express love in their own ways.  Dr. Lidia Schapira: I can just imagine you're thinking about that when you're in a room and you're sort of casting people, "Oh, this is a Grandpa Joe. He means well, he loves a lot, but we just need to help him to understand what's happening." And there's another character in your story that I want you to talk a little bit about, and that's Kevin, the loving partner and caregiver, who's first sort of marginalized by the large group descending upon them and claiming John. And then there's a scene where there's peace between all factions. Tell us a little bit about how that felt to you, witnessing it as a child and how you thought about it in the years that came later.  Dr. Matthew Farrell: Yeah, I was still very young at the time, but these scenes completely seared themselves into my memory. And the piece that ended up coming out of this scene was due to Kevin and Kevin alone and his love for John, which he communicated so well, as well as the knowledge he had of John's wishes that other people didn't have. That is what allowed people to come together and to begin healing. And it has reminded me that it is never too early to share your wishes with people you love who can then be advocates for you when you can no longer advocate for yourself. I tend to think about it this way: when you communicate your wishes to other people, you are allowing yourself to get the type of care you want and not get the type of care that you don't want. But you're also giving a gift to your loved ones because by Kevin communicating what John wanted to our family, to John's father, it gave everyone the confidence that they knew that they were giving John what he wanted. And that provided a lot of comfort. So if you share that with someone and then they have certainty that they're helping you achieve what you would want. And that's the gift that Kevin gave to our family that none of us will ever forget.  Dr. Lidia Schapira: I think the use of the word ‘gift' is wonderful, totally appreciated. And I understand you're very deliberate with your choice of words, so I appreciate that. I think that we don't quite know how to value sometimes some of the gifts that our patients give us in the exam room, at the bedside, in terms of how they help us, help them by being clear, by expressing their gratitude often. And you bring that out so beautifully.  So as a gifted and trained writer who's now embarking on a career in radiation oncology, how are you going to continue to combine these talents? Are you writing a play or what are your plans?  Dr. Matthew Farrell: I still just write a lot in whatever comes to me. And I do write a lot about medicine and also a lot not about medicine. And it's fun for me. I did study writing formally, but I still have tons to learn all the time and I'm still learning from other people. And I try to be as open as I can to feedback in my own writing. I am, among other things, trying to write a screenplay, like many people in LA. I also worked briefly in the film industry for a summer at a film management company, and there was this joke about how everyone in LA is writing a screenplay, but almost no one has written a screenplay. And so I'm unfortunately still in the former category, but working on it. Dr. Lidia Schapira: Is there something you've learned working in the film industry that you want to share with your colleagues working in oncology that could help us be better doctors?  Dr. Matthew Farrell: One is just, I think, movies, shows, writing, a lot of it is focused on people and humanity and the human condition. And I find those stories very moving. And those sorts of stories are also very present and central in medicine. I think that obviously, by getting to know people, you can help them achieve what they want. I know that, again, this whole story was my first encounter with the limitations of medicine and when there aren't very many treatment options available to help people therapeutically. But still, there were many good outcomes for us to work toward in this situation, and in oncology, too. Whether that's helping to provide understanding, helping people come together, helping provide comfort. I know hospice and palliative care was incredibly helpful to John, and that's one of the things that I like about radiation oncology, among many other things, is its role in palliative care, and palliation in terms of reducing pain, reducing bleeding, reducing suffering, enabling functional gain and quality of life. And yeah, I think that the stories that I encountered in movies, which I got a great appreciation for, among other things from John, and the stories that I read about in my study and writing, I still am learning and experiencing those stories in medicine. And it's been each kind of phase that I was in have been incredibly moving to me and have helped me grow as a person.  Dr. Lidia Schapira: So before we end, I have to ask you this question. Do you have a favorite illness memoir or story that has been published or has been used to inform a play?  Dr. Matthew Farrell: One of the writers that I've studied the most who wrote about medicine as well as illness was Anton Chekhov. I took a whole course on him when I was in graduate school and he was a physician, one of the great physician writers of all time. And he wrote about, in contrast to what a lot of other writers were writing about at the time, he wrote about doctors, people, peasants, everyday humanity in really moving ways. And he just has so many stories about illness and pain and loss that are all worth reading.  Dr. Lidia Schapira: Well, thank you. It's been a lovely conversation. We enjoyed reading your story and learning about the family. Thank you for sharing that with us.  Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of the ASCO's Shows at asco.org/podcasts.  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. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio:   Dr. Matthew Farrell is a radiation oncology resident at UCLA.

Michael Stevens joins Purposely to share his founder story developing and launching the Rainbow Tick. Michael's mission was to support the rainbow community in a tangible way, helping the community to gain acceptance and inclusion in the workplace and he had seen similar initiatives abroad. ‘It was about positively impacting people's mental health and about accepting and valuing people in the workplace, embracing the diversity of sexual and gender identities.' The first programme of its kind in New Zealand, organisations undertake an accreditation process carried out by an independent assessor receiving the Rainbow Tick a visible sign that business embraces all genders and sexual identities. As a gay man, Michael knew from personal experience how important this initiative would be for future generations. Michael initially struggled to accept his own sexual identity and had to deal with a school culture that wasn't fully inclusive or accepting. In 1988 Michael was diagnosed as HIV+, he was 27 years old and living in Istanbul, Turkey. The following years were filled with anger, sadness, sickness and acceptance, as he believed he had only a few years to live. That was nearly 30 years ago. Now, he's in his 60's. ‘I spent so long thinking about and planning my own death during those years, although it didn't happen' In 1988, the HIV/Aids epidemic was sweeping the world. many of his gay friends began to talk about it, and when his flatmate in Istanbul tested positive he decided he should get tested too. Michael travelled to London to receive his test. The doctor at the clinic told him he had HIV, and advised him to go home to New Zealand and prepare to die within the next two years. ‘I felt absolutely devastated and I went into a deep depression, but I decided I wasn't ready to go home, so I returned to Istanbul.' ‘When I told my family, they were upset for me of course, but fully supportive. I know a lot of people were cut off, but luckily for me this wasn't the case.' In the next few years, Michael said he didn't feel too bad, but in 1993, he received the news one of his closest friends who was diagnosed around the same time as him, had died. ‘I figured if he'd now died from it, I probably didn't have much time left. So I decided to go home for his funeral and prepare for my own.” The next year, Stevens became sick. He contracted tuberculosis and Pneumocystis pneumonia, a type of pneumonia often associated with a weakened immune system caused by HIV. He lost a large amount of weight in a short span of time and was constantly tired. He could no longer walk up the stairs at work without getting out of breath. It was at this stage he was told his HIV had progressed to its final stage, known as AIDS (Acquired Immune Deficiency Syndrome). Michael was in his thirties at this point. Michael was admitted to the ‘AIDS ward' of Auckland Hospital but later released to Herne Bay House, a residential centre and hospice dedicated to caring for people diagnosed with HIV. Michael believed this is where he was going die. “I had been very angry and bitter about the situation up until this point. My attitude almost got me thrown out of the hospice, but eventually, I came more to terms with it and began to plan my death” Today he describes how the stigma has really decreased around having HIV, it has become much less pronounced as many people have a better understanding of it. “A lot of it was just fear really, people were afraid, and they didn't understand why it was happening” “If you think of the friends you make in your late teens and early 20s, they're often the friends that are with you for life. “Nearly all of my gay friends had HIV, and so many died. So many gay men from my youth are not here to turn 60 with me” Michael currently works as a relationship manager for Be.Lab a New Zealand based organisation which helps businesses and organisations to be more accessible. Prior to this he has was part of the AKL Uni Sociology Department. --- Send in a voice message: https://anchor.fm/mark-longbottom2/message

On the third episode of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the previous two weeks, 5/11/22 – 5/25/22. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Monkeypox Virus Infection in the United States and Other Non-endemic Countries—2022 (CDC) Monkeypox course (WHO) Monkeypox on TWiV 902 and TWiV Special Progress Toward Polio Eradication — Worldwide, January 2020–April 2022 (MMWR) Capsid Inhibition with Lenacapavir in Multidrug-Resistant HIV-1 Infection (NEJM) Rabies in a Dog Imported from Azerbaijan — Pennsylvania, 2021 (MMWR) Burden, clinical characteristics, risk factors, and seasonality of adenovirus 40/41 diarrhea in children in eight low-resource settings (Open For Inf Dis) Comparison of 8 vs 15 days of antibiotic therapy for Pseudomonas aeruginosaventilator-associated pneumonia in adults (Intensive Care Med) High prevalence of Pseudomonas aeruginosa carriage in residents of French and German long-term care facilities (Clin Micro Inf) Antibiotic treatment duration for community acquired pneumonia in outpatient children in high-income countries – a systematic review and meta-analysis (Clin Inf Dis) Follow-up Blood Culture Practices for Gram-Negative Bloodstream Infections in Immunocompromised Hosts at a Large Academic Medical Center (Open For Inf Dis) Meningococcal disease and immunization activities in Hajj and Umrah Pilgrimage: a review (Inf Dis Therapy) Treatment with reduced dose trimethoprim-sulfamethoxazole is effective in mild to moderate Pneumocystis jirovecii pneumonia in patients with hematologic malignancies (Clin Inf Dis) Occupational risk of cutaneous larva migrans: A case report and a systematic literature review (PLoS NTD) Quinacrine Treatment of Nitroimidazole-Refractory Giardiasis (JID) Diagnosis and management of infective endocarditis in people who inject drugs(JACC) A mechanistic model of snakebite as a zoonosis: Envenoming incidence is driven by snake ecology, socioeconomics and its impacts on snakes (PLoS NTD) Strategies to prevent central-line associated bloodstream infections in acute-care hospitals (Infection Control & Hosp Epi) Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute care hospitals (Infection Control & Hosp Epi) Use of benznidazole to treat chronic Chagas disease: An updated systematic review with a meta-analysis (PLoS NTD) Chagas Disease: The New HIV/AIDS of the Americas (PLoS NTD) Digital Strategy and Social Media in Infectious Diseases (Clin Inf Dis) Intro music is by Ronald Jenkees Send your questions for Puscast to puscast@microbe.tv

For the second episode of Infection Prevention in Conversation, Gemma Winzor is joined by the editors of the Journal of Hospital Infection, Jim Gray (Birmingham Women's and Children's Hospital) and Nik Mahida (Nottingham University Hospitals). The group discuss five papers, linked via their titles below, and share their thoughts on how to work - and have difficult conversations with - colleagues from a range of departments, what we take for granted in infection control, and how the pandemic has brought IPC into focus worldwide. Twitter: @jhieditor @IPIP_openEpisode links:Castro-Sánchez et al. Evaluation of a personal protective equipment support programme for staff during the COVID-19 pandemic in London. Journal of Hospital Infection, Volume 109, 68-77.Chamseddine et al. Detection of influenza virus in air samples of patient rooms, Journal of Hospital Infection, Volume 108, 33-42.Kinnevey et al. Meticillin-resistant Staphylococcus aureus transmission among healthcare workers, patients and the environment in a large acute hospital under non-outbreak conditions investigated using whole-genome sequencing. Journal of Hospital Infection, Volume 118, 99-107.Halstead et al. Pseudomonas aeruginosa infection in augmented care: the molecular ecology and transmission dynamics in four large UK hospitals. Journal of Hospital Infection, Volume 111, 162-168.Pougnet et al. Pneumocystis exhalation by infants developing Pneumocystis primary infection: putative infectious sources in hospitals and the community. Journal of Hospital Infection, Volume 113, 10-13.Nevez et al. A proposal for pragmatic investigation of possible clonal clusters of pneumocystis pneumonia cases. Journal of Hospital Infection, Volume 108, 215-216. Hosted on Acast. See acast.com/privacy for more information.

Snack Pax is back with another episode of Epi After Dark. This week as we progress through the House of Opportunists Pax examines the most important defining features of the early AIDS Crisis through examination and retrospective analysis of the June 5, 1981, and July 3, 1981, MMWR issues that alerted medical professionals to the crisis. The Master of Ceremonies and Curious Wanderer manage to escape the Inverted Pole only to discover there is more than meets the eye when it comes to the Oculary of Lies. Check back next week for the next episode where we cover Cytomegalovirus.

In this episode we cover the rare but important driver of your patients respiratory failure:  Pneumocystis Jiroveci Pneumonia. Come listen to why you should always delineate HIV status, how to approach patient workup and treatment via an invasive and non invasive manner, and why heatwaves is just a sick song.

Merhaba! Daha önceden HIV enfeksiyonunun seyri ve profilaksi üzerine ilk yazıyı paylaşmıştık. Bu yazıda ise HIV enfeksiyonuna ait çeşitli komplikasyonlar ile acil servise başvuran hastaların yönetimi üzerinde duracağız.​1​ ​2​ ​3​ Unutulmamalıdır ki antiretroviral tedaviye uyum gösteren hastalar, saptanamayan viral yüke, iyileştirilmiş yaşam kalitesine ve normal yaşam beklentisine ulaşabilir. Tedavi uyumsuzluğu olan veya henüz tanı almamış hastalar fırsatçı enfeksiyonlara ve ateş, kilo kaybı, yorgunluk ve halsizlik gibi sistemik semptomlara daha yatkın olabilir. HIV ile yaşayan bireyler için en önemli başvuru nedenlerinden biri ateştir.​4​ Bu hastaların fırsatçı enfeksiyonlara yakalanma ihtimalini ise en çok CD4+ T lenfosit sayısı değiştirir. Genel olarak, CD4+ T lenfosit değerleri

Lower respiratory tract infections are still the world's most fatal communicable disease. Community acquired pneumonia specifically is one of the most common infections managed by clinicians in daily practice. On this episode of Microbe Mail, host Dr Vindana Chibabhai speaks to Pulmonologist, Dr Erica Shaddock about diagnosing and managing CAP. About our Guest: Erica Shaddock is a specialist Pulmonologist Pulmonologist at Charlotte Maxeke Johannesburg Academic Hospital since 2009. Her special interests include COPD, Pneumonia , PCP and Covid-19. She is currently registered for her PhD focussing in the immune response and modulation in Pneumocystis pneumonia patients . She has been an integral member of the Covid-19 team at the Charlotte Maxeke Johannesburg Academic Hospital. She is also a senior lecturer in the Department of Internal Medicine at the University of the Witwatersrand. Visit the Microbe Mail https://microbemail.captivate.fm/ (website) to sign up for updates E-mail: mail.microbe@gmail.com YouTube: https://www.youtube.com/channel/UCgaP3aUNkjrgOxR8Ei6UaEw (Microbe Mail) Instagram: https://instagram.com/https:/www.instagram.com/microbe_mail/ (Microbe_Mail)  South African  Community Acquired pneumonia guidelines https://jtd.amegroups.com/article/view/13850/html (here) Access “Gender differences in community acquired pneumonia” article https://pubmed.ncbi.nlm.nih.gov/32166931/ (here)

♦ Esiste una lista ufficiale di malattie legate direttamente al mondo omosessuale. Secondo la rivista Science News, una “rara forma di cancro e spesso rapidamente fatale”, chiamata sarcoma di Kaposi, è stata diagnosticata in decine di omosessuali. Alcuni di loro sono morti entro 24 mesi dalla diagnosi. Secondo l'articolo, analizzando le cose in comune fra le vittime, è stato riscontrato che avevano “frequenti incontri sessuali con molti partner diversi” e “molte di loro erano già state trattate per herpesvirus, citomegalovirus, virus dell'epatite B e infezioni parassitarie”, malattie comuni fra gli omosessuali. Secondo Medical World News, gli epidemiologi di San Francisco, California, e di altre grandi città americane hanno condotto studi approfonditi alla ricerca di indizi che spieghino perché la polmonite da Pneumocystis carinii – una pericolosa malattia, spesso letale, che è solitamente associata a una grave immunosoppressione – si è improvvisamente manifestata in giovani omosessuali sani. La rivista aggiunge che i medici “sospettano che il denominatore comune possa essere una pratica unicamente omosessuale o una malattia nascosta acquisita con il rapporto sessuale”. --- 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/corgiov/message

Episode 70: HIV Prevention. Prevention is key in controlling HIV-AIDS. Listen to ways to prevent HIV, mainly by using condoms, PrEP and PEP.Introduction: HIV and AIDSBy Robert Dunn, MS3.Introduction: The Human Immunodeficiency Virus (HIV) is a retrovirus that is primarily transmitted via sex, needles or from mother to fetus. Once infected, the virus increases in its copies and decreases the individual's CD4+ cell count, thus leading to an immunocompromised state known as Acquired Immune Deficiency Syndrome (AIDS). Once with AIDS, the patient is susceptible to opportunistic infections. Prevention from AIDS includes several options. Condoms for safe sex practices are the least invasive and most readily accessible option for all patients. Pre-exposure prophylaxis (PrEP) is also an option for men who have sex with men (MSM) and transgender women. If the patient is also exposed to HIV, post-exposure prophylaxis (PEP) may also be an option to prevent infection but must be administer ideally 1-2 hours after exposure but no later than 72 hours after. Today we will briefly discuss how to prevent HIV infection.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.___________________________HIV Series IV: HIV Prevention. By Robert Dunn, MS3.Participation by Huda Quanungo, MS3; Bahar Hamidi, MS3; and Hector Arreaza, MD.  HIV PreventionIntroductionThe Human Immunodeficiency Virus (HIV) is a retrovirus that is primarily transmitted via sex, needles or from mother to fetus. Once infected, the virus increases in its copies and decreases the individual's CD4+ cell count, thus leading to an immunocompromised state known as Acquired Immune Deficiency Syndrome (AIDS). Once with AIDS, the patient is susceptible to opportunistic infections. Prevention from AIDS includes several options. Condoms for safe sex practices are the least invasive and most readily accessible option for all patients. Pre-exposure prophylaxis (PrEP) is also an option for men who have sex with men (MSM) and transgender women. If the patient is also exposed to HIV, post-exposure prophylaxis (PEP) may also be an option to prevent infection, but it must be administered ideally 1-2 hours after exposure but no later than 72 hours after. We will concentrate in prevention during this episode.   What is HIV?The Human Immunodeficiency Virus (HIV) is a retrovirus. When the virus gains access to our body via cuts on the skin or mucosa:The virus injects its 10kb sized RNA genome into our cells. The RNA is transcribed to DNA via viral reverse transcriptase and is incorporated into our cellular DNA genome. This causes our cells to become a virus producer. Viral proteins translated in the cell are transported to the edge of the cell and can bud off into new viruses without lysing the cell.  Acute HIV symptoms. Some potential early symptoms of HIV can include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, lymphadenopathy, and mouth ulcers. The most common acute symptom is NO SYMPTOM. Many people do not feel sick with the acute infection of HIV. Some people can live years with HIV in “clinical latency” without knowing they are infected, but they can still be contagious during this time. As viral load (the amount of virus copies you have in your blood stream) increases, the CD4+ cells that contribute to our adaptive immunity continues to fall. That's why the best test during this period is not going to be HIV antibody but you should test for antigens. Specifically, the 4th Generation HIV test, which tests for both antibody and p24 antigens.Chronic symptoms. Once patients begin to present with opportunistic infections (i.e. Pneumocystis pneumonia – PCP), or have a CD4 count below 200, the patient is considered to have Acquired Immune Deficiency Syndrome (AIDS) and makes them susceptible to more serious infections. Without treatment, patients with AIDS typically survive about 3 years. Epidemiology of HIVHIV incidence: In 2019, there were 34,800 new HIV infections in the United States. This is an 8% decline from 2015. Amongst age groups: Age 25-34 had the highest rate of incidence (30.1 per 100,000)Age 35-44 had the second highest rate (16.5 per 100,000)Age 45-54 remained stableAge 13-24 had decreasing rates of incidence Amongst ethnic groups: Black/African-American groups has the highest rate of incidence (42.1 per 100,000)Hispanic/Latino had the second highest rate (21.7 per 100,000)Person of multiple races had the third highest (18.4 per 100,000) Amongst sex: Males had the highest rate of incidence (21 per 100,000)Females had the lowest rate of incidence (4.5 per 100,000) HIV Prevalence:In 2019, 1.2 million people (Ages 13 and older) in the US have HIV and 13% of them do not even know it. In 2020, there were an estimated 1.5 million people worldwide that acquired a new HIV infection. This is a 30% decline since 2020. An estimated 66% are receiving some HIV care and 57% were virally suppressed. Mortality: In 2019, there were 15,815 deaths among adults and adolescents diagnosed with HIV in the US. Preventative ScreeningThe USPSTF gives a Grade A recommendation for HIV screening for: Pregnant people and everyone between 15-65 years of age. All pregnant people at any point of their pregnancy, including those who present in labor or delivery and have an unknown status of HIV.The USPSTF only recommends a one-time screening and shows no benefit of repeat screening thereafter. Women may also be screened for subsequent pregnanciesAlso screen all Adolescents and adults ages 15-65.  An effective approach is routine opt-out HIV screening. This approach includes HIV screening as part of the standard preventive tests. This approach removes the stigma associated with HIV testing, it promotes earlier diagnosis and treatment, reduces risk of transmission, and it is cost-effective. The determination for repeated screening of individuals should take into account the following risk factors: -Men who have sex with men (MSM)-Individuals who live in areas with high prevalence of HIVIncluding attending to tuberculosis clinics, stay in a correctional facility, or homelessness-Injection drug use-Transactional/commercial sex work-1 or more new sexual partners -History of previous STIs Annual screening for HIV is reasonable, however, clinicians may want to screen patients every 3-6 months if they have an increased risk of HIV.  CondomsA simple and very effective method in HIV prevention is the use of condoms for safe sex practices. In 2009, the American College of Physicians (ACP) and the HIV medicine Association called for the wider availability of condoms and education to minimize HIV transmission. A meta-analysis of 12 HIV studies amongst heterosexual couples demonstrated the use of condoms in all penetrative sex acts reduced the risk of HIV transmission 7.4 times in comparison to those who never used condoms. Other studies show a 90-95% effectiveness in HIV prevention when “consistently” using condoms. A Cochrane review shoed that the use of a male latex condom in all acts of penetrative vaginal sex reduced HIV incidence by 80%. Overall, condoms are effective in HIV prevention.Pre-Exposure Prophylaxis (PrEP)Truvada and Descovy:Another option for prevention amongst HIV negative individuals is the use of Pre-Exposure Prophylaxis (PrEP). It is an anti-retroviral pill that is taken daily to maintain a steady-state level of the medication in the blood stream. The medication specifically a combination of 2 antiretroviral medications – Tenofovir and Emtricitabine. Both medications are nucleoside reverse transcriptase inhibitors (NRTIs) that work by blocking the viral reverse transcriptase from HIV and prevent the enzyme from copying the RNA genome into DNA. Therefore, it stops viral replications. There are 2 formulations of PrEP: Truvada and Descovy. Truvada's primary side effects are renal and bone toxicity with long-term use. Descovy's primary side effects are mild weight gain and dyslipidemia. Truvada is the most commonly prescribed PrEP because it has the most data since it has been around the longest. However, extra consideration should be taken for: Adolescents should weigh at least 35 kg before being prescribed PrEPDescovy may be preferred for adolescents by the prescribing physician as it is not associated with reduction in bone density, as Truvada is. Estimated GFR between 30 – 60Truvada is associated with acute and chronic kidney disease whereas Descovy is safe for patients with a GFR greater than 30Patients with osteoporosisTruvada is associated with bone toxicity, whereas Descovy is not. It is important to note that PrEP has only been studied in men or people who were assigned men at birth. So, its efficacy in vaginal sex and with vaginal fluids cannot be generalized at this time. Future of PrEP: In May 2020, the HIV Prevention Trials Network (HPTN) 083 randomized trial demonstrated the potential of an injectable PrEP. Carbotegravir, is an integrase inhibitor, which prevents the HIV integrase from incorporating the HIV genome into the cellular genome. This study demonstrated its efficacy as PrEP in comparison to Truvada with few new infections (13 versus 39, respectively). Carbotegravir would be given via injection once every 8 weeks. In September 2021, the pharmaceutical company Moderna will begin 2 human clinical trials for an HIV vaccine that use mRNA technology. Previous studies conducted with non-mRNA vaccines demonstrated that B cells can be stimulated to create antibodies against HIV. Since HIV becomes integrated in the cellular genome within 72 hours of transmission, a high level of antibodies must be produced and present in the body to offer an adequate level of immunity. Post-Exposure Prophylaxis (PEP)If an individual is exposed to blood or bodily fluids with high risk of HIV via percutaneous, mucus membrane or nonintact skin route, post-exposure prophylaxis (PEP) may be an option. PEP is indicated when the HIV status of the exposure source is unknown and are awaiting test results, or if the exposure source is HIV positive. Therapy should be started within 1 or 2 hours of exposure and it is not effective after 72 hours of initial exposure. The recommended duration of therapy is 4 weeks but no evidence has been shown for an optimal duration. Occupational exposure. There are 2 regimens for PEP: Truvada with Dolutegravir Truvada  with Raltegravir Both Doltegravir and Raltegravir are integrase inhibitors which block the integration of the viral genome into the cellular DNA. The regiments are chosen based on efficacy, side effects, patient convenience, and completion rates. Dolutegravir is chosen because it is given once daily. While Raltegravir is taken twice daily, most experience with PEP has been with Raltegravir. Other risk with Raltegravir are potential skeletal muscle toxicity and systemic-cutaneous reactions resembling Steven-Johnson syndrome. One final word about prevention of vertical transmission is making sure pregnant women are treated during pregnancy and if the baby is delivered from a patient whose viral load is “detectable”, the baby needs to be treated, but we'll let that topic for another time to discuss. Joke: What do you call the patient zero of HIV? First Aids.HIV incidence is decreasing thanks to many prevention measures taken globally, and we discussed screening, condoms, PrEP and PEP as part of this prevention efforts. Stay tuned for more relevant medical information in our next episode. ____ Now we conclude our episode number 70 “HIV Prevention.” Robert, Huda and Bahar explained some ways to prevent HIV, mainly by screening those at risk, using condoms, PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis). Let's also remember that having a monogamous relationship and avoiding high risk sexual behaviors confer significant protection against HIV. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Robert Dunn, Huda Quanungo, and Bahar Hamidi. Audio edition: Suraj Amrutia. See you next week!   References:About HIV. Center for Disease Control and Prevention, CDC.gov, June 1, 2021. https://www.cdc.gov/hiv/basics/whatishiv.html . Accessed September 21, 2021. Simon V, Ho DD, Abdool Karim Q. HIV/AIDS epidemiology, pathogenesis, prevention, and treatment. Lancet. 2006 Aug 5;368(9534):489-504. doi: 10.1016/S0140-6736(06)69157-5. PMID: 16890836; PMCID: PMC2913538. [https://pubmed.ncbi.nlm.nih.gov/16890836/]   US Statistics. HIV.gov, June 2, 2021. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics . Accessed September 21, 2021.  The global HIV/AIDS Epidemic. HIV.gov, June 25, 2021. https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics. Accessed September 21, 2021.  Human Immunodeficiency Virus (HIV) Infection: Screening. U.S. Preventative Services Task Force, June 11, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening. Accessed September 21, 2021.  Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ. 2004 Jun;82(6):454-61. PMID: 15356939; PMCID: PMC2622864. [https://pubmed.ncbi.nlm.nih.gov/15356939/] Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1):CD003255. doi: 10.1002/14651858.CD003255. PMID: 11869658. [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003255/full] Mayer, Kenneth H, MD, and Douglas Krakower, MD. Administration of pre-exposure prophylaxis against HIV infection. UpToDate, June 24, 2020. Accessed September 21, 2021. [https://www.uptodate.com/contents/administration-of-pre-exposure-prophylaxis-against-hiv-infection?search=8)%09Administration%20of%20pre-exposure%20prophylaxis%20against%20HIV%20infection&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1] Zachary, Kimon C, MD. Management of health care personnel exposed to HIV. UpToDate, June 07, 2019. Accessed September 21, 2021. [https://www.uptodate.com/contents/management-of-health-care-personnel-exposed-to-hiv?search=9)%09Management%20of%20health%20care%20personnel%20exposed%20to%20HIV&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1]

Episode 67: Covid, Food, and HIV.  Medical students discuss the relationship between high cholesterol and COVID-19, the effect of food order in postprandial glucose and insulin, and HIV history. Moderated by Hector Arreaza, MD.  During this episode you will listen to three medical students discussing some topics that they found interesting during their family medicine rotation. All the credit goes to them because they read these topics and provided a very good summary. I hope you enjoy it.____________________High Cholesterol and COVID-19By Milan Hinesman, MS3, Ross University School of MedicineGiven the current state of the world, there's been a lot more attention to COVID-19 presentation, risks, and treatment. One study conducted by Dr. Kun Zhang and collaborators shows that there may be a relationship between higher total cholesterol levels and ApoB levels to increased risk of COVID-19 infection[1]. Dr. Zhang used a mendelian randomization from the UK Biobank data to test for lipid effects on COVID susceptibility and severity. The study performed analysis of data from the host genetics initiative consisting of more than 14,000 cases and more than one million controls showing a potential positive causal effect between high total cholesterol and ApoB and COVID susceptibility. A mendelian randomization is a process of taking genes which functions are already known and measuring their response to exposure to a disease in observational studies[2]. In short, high cholesterol and high ApoB are linked to COVID-19 infection.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. __________________________Impact of food order on glucose after meals.   By Yvette Singh, MS3, American University of the CaribbeanIn the management of diabetes, health care providers usually assess glycemic control with fasting plasma glucose and pre-prandial glucose measurements, as well as by measuring Hemoglobin A1c. Therapeutic goals for Hemoglobin A1c and pre-prandial glucose levels have been established based on the results of controlled clinical trials. Unfortunately, many patients with diabetes fail to achieve their glycemic goals. Elevated glucose after eating may be the cause of poor glycemic control leading to vascular complications. Postprandial hyperglycemia is one of the earliest abnormalities of glucose homeostasis associated with type 2 diabetes. This is one of the important therapeutic targets for glycemic control. Current studies show that the amount and timing of carbs in the diet primarily influence blood glucose levels. Other studies also show that eating whey protein before meals, as well as changing the macronutrients in meals, reduces postprandial glucose levels; however, these studies did not have patients with type 2 diabetes. The main author of this study was Alpana P. Shukla and many other collaborators. The title is Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels, published by the American Diabetes Association on Diabetes Care in July 2015.This study was performed to analyze the order of food consumption with vegetables, protein and carbohydrates and its effects on postprandial glucose in overweight/obese patients with type 2 diabetes being treated with metformin. Subjects were studied for 1 week. They were given a meal with the same number of calories, after fasting for 12 hours: 55g protein, 68g carbs, and 16g fat. They were asked to eat carbs first, then to eat vegetables and protein fifteen minutes later. This order was reversed during the second week. Their postprandial glucose and insulin levels were measured at 30/60/120 mins after meals. The statistical studies showed an average post prandial glucose decrease by more than 25% when protein was consumed first. As well as the average post prandial insulin levels decreased by more than 40%. These results demonstrated that the timing of carbs during a meal has a significant impact on glucose and insulin levels comparable to some pharmacological agents. Reduced insulin excretion with this meal pattern may also improve insulin sensitivity. This may help patients with type 2 diabetes control their HbA1c, and possibly help reverse early diabetes. Educating patients about this approach is not controlling how much they are eating or restricting their diet so patients will likely comply with this recommendation. Eat your protein first!The potential problems of this study are that it was a small sample size (11 patients), limited food types, and insulin was measured only up to 120 minutes after meals. Further studies are needed to demonstrate the full effectiveness of this recommendation.___________________HIV Series Part I: HIV HistoryBy Robert Dunn, MS3, Ross University School of Medicine This is an HIV series for the Rio Bravo qWeek Podcast. The following episodes will include some of the history of HIV, transmissibility, the PARTNER-1 and PARTNER-2 studies, and will finalize with a full episode on HIV prevention. Today we are starting with HIV history.Prejudice against those with HIV stems from the history surrounding the virus. Between 1981-1983, cases of rare infections like Pneumocystis carinii pneumonia (PCP) and aggressive cancers like Kaposi Sarcoma were appearing predominantly amongst gay men and injection drug users.  Even children were presenting with AIDS creating misconceptions of how the disease was transmitted by touch. By 1982, this syndrome was referred to as the Gay-Related Immunodeficiency (GRID), which we now know as AIDS. Some History of HIVThe start of the Human Immunodeficiency Virus (HIV) was thought to have started in the Democratic Republic of Congo in 1920 when the virus crossed species to humans and gave its ability to infect humans[4]. In 1981, five young gay men in Los Angeles, California, presented with a rare lung infection called Pneumocystis carinii pneumonia (PCP). Two other groups of men also presented with a rare and aggressive cancer called Kaposi Sarcoma, in New York and California. By December of the same year, the first case of PCP was found in an injection drug user. And by the end of the year, there were 270 reported cases of this severe immunodeficiency and about 121 of them had already died from it, almost 50%. In 1982, due to the prevalence of these rare diseases being present among gay men, the syndrome was called the Gay-Related Immune Deficiency (GRID). The CDC later officially called the disease the Acquired Immune Deficiency Syndrome (AIDS). The term “gay cancer” was used in Venezuela before AIDS was known.In 1983, the disease was found in both women and children. In May 1983, in a joint conference between the Pasteur Institute in France and the National Cancer Institute, they announced that LAV and HTLV-III were the same virus and the cause of AIDS.In 1985, Ryan White, a teenager with hemophilia was banned from school when he was diagnosed with HIV after he received contaminated blood products. Ryan later died at 18 years old due to AIDS-related illnesses. At the same time, the FDA licensed the first commercial blood test to detect HIV. A foundation was later created to provide primary care and medications for low-income HIV patients.In 1987, the first antiretroviral drug, Zidovudine (AZT) was approved by the FDA to treat for HIV. In 1991, the famous basketball player Magic Johnson announced he tested positive for HIV and retired immediately. After his retirement he planned to educate young people about the virus which helped dispel stereotypes. Also in 1991, the famous singer of Queen announced he had AIDS and died the next day.In 1993, the movie Philadelphia with Tom Hanks promoted further discussion about HIV and AIDS. In June 1995, the first protease inhibitor was approved by the Food and Drug Administration (FDA), which started the era for Highly Active Antiretroviral Therapy (HAART). This brought down the rate of AIDS-related deaths and hospitalizations by 60-80%. Of special note, in 1986, the FDA passed the policy to ban all men who had sex with men (MSM) from 1977 onward, from donating blood or plasma to avoid the risk of transmitting HIV or Hepatitis A. This policy was amended in December 2015, when the revised policy said any MSM within the last 12 months, would need to wait at least 1 year before donating blood. In light of the COVID-19 pandemic, the FDA amended it its policy once more to decrease the wait time to 3 months form the last time the man had sex with another man.____________________________Conclusion: Now we conclude our episode number 67 “Covid, Food, and HIV.” Kudos to Milan, Yvette and Robert, they presented relevant information for our practice of medicine. They taught us that high cholesterol is a risk for COVID-19 infection; Also, when you eat proteins first, your glucose and insulin after meals are lower than when you eat carbs first; and you will be hearing from Robert for a couple episodes regarding HIV. Today he gave us a little piece of HIV history. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Milan Hinesman, Yvette Singh, and Robert Dunn. Audio edition: Suraj Amrutia. See you next week! _____________________References:Zhang, K. Dong, S. Guo, et. al., Causal Associations Between Blood Lipids and COVID-19 Risk: A Two-Sample Mendelian Randomization Study. Arteriosclerosis, Thrombosis, and Vascular Biology, originally published on September 9, 2021. https://doi.org/10.1161/ATVBAHA.121.316324. What is Mendelian Randomization and How Can it be Used as a Tool for Medicine and Public Health? Opportunities and Challenges, Webinar announcement given by Professor George Davey Smith on November 27, 2018. Centers for Disease Control and Prevention, https://www.cdc.gov/genomics/events/precision_med_pop.htm Alpana P. Shukla, Radu G. Iliescu, Catherine E. Thomas and Louis J. Aronne, Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels, Diabetes Care 2015 Jul; 38(7): e98-e99. https://doi.org/10.2337/dc15-0429. History of HIV and AIDS Overview. Avert, October 10, 2019. https://www.avert.org/professionals/history-hiv-aids/overview. Accessed on September 21, 2021. Shaw, Maggie. FDA's Revised Blood Donation Guidance for Gay Men Still Courts Controversy. AJMC, April 3, 2020. https://ajmc.com/view/fdas-revised-blood-donation-guidance-for-gay-men-still-courts-controvery. Accessed on September 21, 2021. BAYER, R. (2015), Science, Politics, and the End of the Lifelong Gay Blood Donor Ban. Milbank Quarterly, 93: 230-233. https://doi.org/10.1111/1468-0009.12114. Ways HIV can be Transmitted. Centers for Disease Control and Prevention, April 21, 2021. https://www.cdc.gov/hiv/basics/hiv-transmission/ways-people-get-hiv.html. Accessed on September 21, 2021.

In this episode, we review the high-yield topic of Pneumocystis jirovecii Pneumonia (PCP) from the Infectious Disease section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Anthony Fauci Reflects On 40 Years Of HIV/AIDS Research Every week, the Centers for Disease Control and Prevention (CDC) releases its regular report of the latest developments on emerging diseases—a living record documenting decades of medical history, known as the Morbidity and Mortality Weekly Report (MMWR). In May 1981, former MMWR editor Michael B. Gregg got a call about an unusual deadly pneumonia, seen in young gay men in Los Angeles. The tip was from epidemiologist Wayne Shandera, Epidemic Intelligence Service Officer for the Los Angeles County Department of Health. He described the cases of five men, ages 29 to 36, who had developed Pneumocystis carinii, a kind of pneumonia typically seen in cancer and immunosuppressed patients. These men were previously healthy, yet they struggled to fight off the illness with treatment. Two of the patients died. All five were gay. Gregg didn’t know what to make of the cases, but he and CDC experts were compelled to publish the observations in the June 5, 1981 issue of MMWR. Soon after, clinicians around the country began to flag similar cases. The number of infected people rose, as did awareness of the strange collection of symptoms. That summer, the media ran stories about the mysterious disease; the New York Times ran the headline, “Rare Cancer Seen in 41 Homosexuals.” At that time, Ira was a science correspondent for NPR, and was in the thick of covering the nuances of the illness. Today marks 40 years since the first official report on the HIV/AIDS epidemic in the United States, and the beginning of a long-puzzling medical mystery. “I was totally baffled, and did not know what was going on. I thought it was a fluke,” recalls Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, during an interview this week with Science Friday. Read more at sciencefriday.com.     Where Did Watermelon Come From? You may think of watermelon as a red, sweet taste of summer. The watermelon itself is ancient—paintings have been found in Egyptian tombs depicting a large green-striped object resembling a watermelon next to grapes and other sweet, refreshing foods. But if you look at many of the melon’s biological cousins, its red, sweet pulp is nowhere to be found—most close relatives of the watermelon have white, often bitter flesh. So how did the modern watermelon become a favorite summer snack? Back in the 1960s, Russian researchers suggested that one sweeter melon species found in south Sudan might have been a close relative of the modern watermelon. Now, a detailed genetic analysis of a handful of wild melon species, and 400 modern varieties of watermelon from around the world, has concluded that the Kordofan melon from Sudan is, in fact, the closest living relative of the watermelon. Susanne Renner, an emeritus professor at the University of Munich and an honorary professor of biology at Washington University in St Louis, explains the work on the origins of the modern melon—and how knowing the history of the watermelon could lead to new varieties. NASA Plans Two New Trips To Venus This week, President Biden announced the U.S. will donate 75% of its unused COVID-19 vaccine doses to foreign countries via the COVAX global vaccine program. The U.S. has promised to promptly send it’s surplus to South and Central America, Asia, and Africa, where countries are experiencing major shortages. Plus on Wednesday, NASA announced plans to launch not one, but two new missions to explore Venus by the end of 2030. It’s the first time the agency has devoted any mission to Venus in 30 years. MIT Technology Review editor Amy Nordrum joins Ira to discuss the biggest science stories of the week.  

In June 1981, the CDC reported an article of 5 men who presented with Pneumocystis pneumonia (PCP). PCP is an opportunistic infection more commonly found immunosuppressed patients (ie. patients receiving chemotherapy for cancer). The 5 men were young and otherwise healthy. They were also all homosexual. In July 1981, another CDC article reported 26 men who presented with PCP as well as Kaposi sarcoma. Kaposi sarcoma is a rare blood vessel tumour. This could not be a coincidence and the world was on the precipice of a pandemic that would kill millions and unleash a wave of homophobia, prejudice and demonization. Fortunately, today, HIV is a manageable disease and patients can continue to live productive and healthy lives which could not be further from this once terminal diagnosis. This is the story of HIV. See omnystudio.com/listener for privacy information.

** Thanks for downloading this episode. If you'd like to stay in touch with our continuing story, Season 2 continues at This Medical Life, in which Dr Travis Brown continues his exploration of diseases and our approaches to treatment from history to the modern day. Have a look in your podcast app now for This Medical Life, and hit subscribe so you never miss an episode ** In June 1981, the CDC reported an article of 5 men who presented with Pneumocystis pneumonia (PCP). PCP is an opportunistic infection more commonly found immunosuppressed patients (ie. patients receiving chemotherapy for cancer). The 5 men were young and otherwise healthy. They were also all homosexual. In July 1981, another CDC article reported 26 men who presented with PCP as well as Kaposi sarcoma. Kaposi sarcoma is a rare blood vessel tumour. This could not be a coincidence and the world was on the precipice of a pandemic that would kill millions and unleash a wave of homophobia, prejudice and demonization. Fortunately, today, HIV is a manageable disease and patients can continue to live productive and healthy lives which could not be further from this once terminal diagnosis. This is the story of HIV.See omnystudio.com/listener for privacy information.

In this episode, Sarah is joined by Dr. Joseph Jemsek, an infectious disease physician who runs the Jemsek Specialty Clinic in Washington, DC. Dr. Jemsek has been on the leading edge of both the HIV and Lyme disease epidemics. He became intrigued by reports of a small cluster of patients with outbreaks of Kaposi Sarcoma and Pneumocystis pneumonia in New York and San Francisco. He intuitively felt that this was an indication of something much bigger.He recalls diagnosing the first HIV patient in North Carolina in 1983, before the disease was even called HIV. In the years that followed, the virus was identified, tests were created and treatments were researched, including an early study for azidothymidine (AZT) which Dr. Jemsek co-authored. This pioneering research study allowed patients access to this early treatment, clinical trial involvement and medical follow up.Get the show notes and resources. 

Welcome back to the tasty morsels of critical care podcast. Pneumocystis Jriovecii Pneumonia, the infection formerly known as Pneumocystis Carinii Pneumonia The official change in name from Carinii to Jirovecii was in the late 1990s to emphasise the distinct organism ... Read More »

This episode covers pneumocystis jiroveci pneumonia!

Today we'll talk about the fungi that was once thought to be a protozoan, Pneumocystis jirovecii. --- Send in a voice message: https://anchor.fm/bradleysmicroboardreview/message Support this podcast: https://anchor.fm/bradleysmicroboardreview/support

Welcome To The MedFlashGo Podcast. This Is Your Daily 4 Minutes Or Less Rapid Review For USMLE, COMLEX, And Shelf Exams. We release a new episode every weekday! In this question of the day, Sean asks students to identify the correct HIV prophylaxis based on the given characteristics described. These questions are powered by MedFlashGo The First Voice-based interactive medical question bank currently available on Alexa. This tool allows medical students to study medical topics and be interactively tested without the use of a screen. You can study on your couch, in your car, and on the move without the use of a screen. To get access to your 50 free questions go on to your Alexa application and search medflashgo In the skills section. To learn more details go to medflashgo.com and check out our frequently asked questions section. Please know that these questions were creatively designed by medical students and physicians for the purpose of education and do not replace health information given from your health professionals. We have tried our best to make sure the information is accurate please, so please let us know if you find any errors and we will be sure to correct them. --- Send in a voice message: https://anchor.fm/medflashgo/message

Dr. Hayes interviews Dr. DeVita about his role as Director of NCI and his time with CHOP and MOPP.   TRANSCRIPT [MUSIC PLAYING] 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. [MUSIC PLAYING] Welcome to JCO's Cancer Stories, The Art of Oncology, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Welcome to Cancer Stories. I'm Dr. Daniel Hayes. I'm a medical oncologist and a translational researcher at the University of Michigan Rogel Cancer Center. And I'm the past president of ASCO. I'm really privileged to be your host for a series of podcast interviews with the founders of our field. In this series of podcasts, I hope to bring appreciation of the courage and the vision and most importantly the scientific background among the leaders who founded our field of clinical cancer care over the last 70 years. I hope by understanding the background of how we got to what we now considered normal in oncology, we can all work together towards a better future for our patients and their families during and after cancer treatment. Today, my guest on this podcast is Dr. Vincent T. DeVita, best known as Vince. Dr. DeVita is generally considered one of the so-called Gang of Five, including Doctors Canellos, Young, Chabner, and Schein, who I've been trying to get on for this podcast in the future, all at the NCI, and who brought many of the concepts we now accept as standard into the clinic in the 1960s and '70s. Dr. DeVita is currently a Professor of Medicine and Epidemiology and Public Health at the Yale School of Medicine. I think it's also fair to say, Dr. DeVita was instrumental in the passage of the 1971 National Cancer Act. And I want to hear more about that as we get into this. He was director of the NCI and the National Cancer Program from 1980 to 1988 and then moved to Memorial Sloan Kettering Cancer Center as Physician in Chief and subsequently became the Director of the Yale Cancer Center in 1993. Among his many honors-- and I don't have time to go through them all-- but he has served as President of the American Cancer Society. And I think most dear to me, he was President of ASCO in 1977 and 1978. Dr. DeVita, welcome to our program. Nice to be here, Dan. I've done a little background. I know you grew up in the Bronx. And I know you went to William and Mary for undergrad and George Washington Medical School. And I also read what I didn't know, which is that you did your internship and residency at the University of Michigan. We're recording this just before the NCAA basketball tourney. And I have to say, go blue. We're all excited here in Ann Arbor about our basketball team. [LAUGHTER] What I'm really interested in is, were your parents physicians? Or what made you choose medicine out of the Bronx? Well, no, my father was a banker. And my mother was an interior decorator. So it was kind of a funny mix. But I think it's kind of peculiar. I was growing up, and my mother-- I tell this story in my book. My mother was kind of frightened by the fact that I really, as a seven- or eight-year-old kid, really thought the guy who delivered the ice-- in those days, we had ice boxes-- was terrific. And I wanted to be like Nunzi the iceman. And she panicked and said, no, no. You're going to be a doctor. And every time someone asked me what I was going to be, I just said I was going to be a doctor. And when I went to school, I decided I'd be a doctor. It was sort of Mama driving me in that direction. So you had a choice of being an iceman or a doctor [LAUGHS]. Right. I like-- I mean, biology was always a favorite subject of mine. So it was a good fit. And tell me about how you ended up going to the NIH and choosing oncology. Was that serendipitous? I talked to Bob Young the other day. And he said, fundamentally, he hadn't planned to be an oncologist and got to the NIH and liked it. Was that your role, or did you know you wanted to do cancer from the start? No, I was going to be a cardiologist. In fact, when I was a first-year resident, I did cardiac catheterizations and was a co-author on a paper that for a long time was well-cited in the field. So I applied to both the Heart and Lung Institute and the Cancer Institute. And those are very competitive positions. And I had an interview with Robert Berliner, which didn't go well [LAUGHS]. So I didn't get invited to the Heart Institute. And I went to the Cancer Institute. And when I walked in, Dr. David Rall was the chief of the pharmacology branch. And I asked him if I could work on the pharmacology of digoxin. And he, wise person that he was, said, sure. Go ahead if that's what you want to do. And I was surrounded by people who were working on anti-cancer drugs. And I actually became fascinated with them. And it was only a few months, because I was also on the wards at the time, that I said, oncology is the way to go. It was an exciting new field. It was kind of a funny field in those days. But I found it exciting, so I switched. So just to give you a plug here, I think many of us know that you wrote a book, The Death of Cancer, published a couple of years ago, co-written with your daughter Elizabeth by the way. But in it, you described a number of things. And one of those that I loved were your stories about Gordon Zubrod. And I trained with Dr. Frei at the Dana-Farber. He always had great things to say about Dr. Zubrod. And I wonder if you could tell the folks listening in who he was-- I think most people don't even know that-- and the impact he had on our field. Yeah, I used to call him the great umbrella. The field was very controversial at the time. And so the people who were doing things like saying, I'm going to try to cure this cancer-- leukemia in Frei's case and Hodgkin's in our case-- were considered just a little bit this side of insane. He was somebody who was distinguished. Now, Frei had-- Zubrod had been at St. Louis as a professor and also at Johns Hopkins. And he was a very distinguished-looking man and a very polite, careful man. And so he used to provide sort of the umbrella for all of us, so that [INAUDIBLE] he'd take the heat. And we could go on and do our work. So he was-- he did enormous number of things. I mean, the whole clinical trial structure was established by Gordon Zubrod. The phase I, II, III trials was all done in a paper by Gordon Zubrod in the late 1950s. So I think he was just a guy who had foresight and was a great leader. I ultimately took his job. He got tired of bucking the bureaucracy and retired and went to Florida as the director of their cancer center there. So I got to know him pretty well. And like Frei, I have great admiration with him. I mean, it's interesting how we take phase I, II, and III for granted. And when he came in, and not too long before you came in, those things weren't-- nobody really knew how to do this stuff. Doctors Frei and Freireich were already at the NCI when you got there, correct? Yes, indeed. Yeah, they were. Yeah. And so they must have been inspirational. They were, and especially Freireich. Freireich was always on the wards. And Tom didn't come over to the wards very much. He was sort of the direct-- he was chief of medicine. And Freireich was the chief of the leukemia service. So we saw Freireich all the time. Tom came over once in a while. And Jay was a super doctor. And it was very hard to stay ahead of him. You'd get an x-ray on a patient. And he'd call you up 20 minutes later and tell you what it was. He was already down looking at it. So you had to stay on your toes with Jay. And of course he was, as everybody knows-- Jay-- he was a bold guy, who-- I mean, he looked like he could walk through a wall. So he frightened a lot of people. But he was an inspiration. So I'm always grateful for what Jay Freireich taught me. There's a great story in your book, that Dr. Frei has told me as well, about the first platelet transfusion at the NCI. Can you elaborate on that? I think most folks don't know about that story. Platelet transfusion was, again, one of those radical departures. But Freireich reasoned that we were losing more people from bleeding than we were from leukemia. So he worked out a way of plasma pheresing people and collecting platelets. And we didn't have a lot of the expertise we have now. And they came in quart bags. I mean, they were plasma bags that were huge. And we were treating little kids. So they were-- throwing them into heart failure was a problem. So it was pretty radical. And he was told to stop doing it by the clinical director at that time. And in fact, he was told that if he didn't stop doing it, he was going to be fired. And he told me-- he said, I went back to my office, sat down, and thought about it. And I decided I didn't want to work at a place where I couldn't do that. So I just kept on doing it. And the person who said he was going to fire him never did. But that was Jay Freireich. [LAUGHS] He believed so strongly in it. And when I went to Yale right after I left the Cancer Institute-- I finished my residency up there. And I told them-- when I saw leukemia patients who were bleeding-- and I said, what you should do is platelet transfusions. And they said, they don't work. And I said, I used them. And I saw them work. So I think we're losing patients unnecessarily. It was just very controversial. So eventually I left the program. I was going to take a residency and then a fellowship in hematology there. And I decided to go back to the Cancer Institute where these adventurous things were going on. Times are different now, of course. Dr. Frei once told me a story that he-- you may have been with him-- that he was making rounds in the clinical center. And in those days, apparently, the adults and the kids were in the same ward. And there was a child with essentially no white cells, who'd been induced for leukemia, and a man next to him with CML. And so-- and actually, when Dr. Frei told me this, I kind of said, I don't think I want to hear this story, because he said, well, you know, the kid didn't have any white cells. And the guy next to him had way too many white cells. So [LAUGHS] I said, tell me you didn't do this. He said, yeah, we took platelets out from the guy and gave them to the kid. And the kid got better for a while. It was really exciting. I thought, boy, you don't see that anymore. Yeah, I mean, it was a very reasonable thing to do, because the white cells in a chronic myelogenous leukemia patient work very well in terms of fighting infection. Yeah. So there was no reason. And the kids, otherwise, wouldn't survive. And so, yeah, I was there when we got these-- we gave these. I mean, they weren't easy to give, because they stuck in the lungs. And we didn't have HLA matching at the time. So they were-- a lot of them were mismatched. But for a while, they were effective. And then we went to collecting white cells from normal people. But the white cells had not worked as well as platelets had worked. Platelets have been a lifesaver. Now it's a couple of hundred million dollar business each year now. So it's routinely done, as many things that Jay started are routinely done now. Of the many things for which you are credited, I think it's the use of combination chemotherapy for Hodgkin's and then subsequently non-Hodgkin's that is one of your lasting legacies. There must have been a lot of drama around doing that. I mean, I think we all just assume you're going to start protocol. You write the protocol. You get funding for it. And you go forward. But can you give us some stories about sitting around at night and thinking about how to do this? Or how did you choose those drugs and why and how to give them and the obstacles that were involved? Yeah, actually, it was a very complicated process. And we didn't have the information we have now. What we had was-- I was doing this with Jack Moxley, who left active medicine and became a dean after he left the Cancer Institute. But we're still in touch. And Jack was working with [? Sy ?] [? Perry ?] using the new isotope, tritiated thymidine, looking at the bone marrow of CML patients and also of mice. And I was doing the same thing with the leukemia 1210, which was a model that we used for chemotherapy all the time. And what we were trying to do was figure out the kinetics of human versus mouse marrow, so we could develop schedules that humans would survive. We quickly found out that you can't use the mouse as a model, because their blood cells went through a kinetic phase about half the length of humans. So you had to schedule in a different way. So we worked that out. And then we looked at very simple-- something that people really ignored is that when you give a chemotherapy agent that is toxic to the marrow, you don't get abnormal blood counts right away. For a week, you'll have a normal white cell. And then on day seven or eight, it begins to fall, because the storage compartment in the marrow works well for about a week. And then there's no replenishment. And the white count falls. So between the two, looking at the marrow and looking at the white cells in the periphery, we came up with a schedule for MOPP. And then the other things were simple. We just decided that you'd have to have three or four drugs that worked by themselves. There had been people doing combination chemotherapy before-- Tom Hall in Boston and [? Alan ?] [INAUDIBLE] at Yale. And their rationale was they're looking at a sequential biochemical blockade. But they ignored whether the drugs actually worked against the tumor, assuming that if you gave them together, that the biochemical blockade would dominate. And it didn't work. In fact, it was very discouraging. But we decided the way to do it was take drugs that had some activity in the disease and use them together and use them in full doses in the schedules that we worked out because of the prior work I was telling you about. So it took a while to put that together. And then Jack Moxley and I used to do this at a bar in Georgetown called the Lehigh Grill, where we used to-- my cardiology desire-- I used to go to Georgetown where there was a wonderful cardiologist Proctor Harvey, who used to hold Thursday night sessions. You had an auditorium that was wired. So you could hear heart sounds. And after that, we'd go to the Lehigh Grill. And we sort of put together the protocol. When we presented it to Tom, he thought it was a good idea. But the other people around him thought it was insane and really tried to stop it. Tom Frei? Yeah. Tom Frei, yeah, yeah. Well, Tom was supportive. Yeah, Emil Frei was his real name. But everybody called him Tom. Yeah, he was supportive. But the people around him and my immediate boss was very much against it, because he thought it would interfere with the protocol that they were doing and so forth. So Tom worked out a solution worthy of Solomon. He said, OK, we could do-- the magic number for phase I trials in those days was 14. If you got nothing in 14 patients, then you didn't go any further. So we could do 14 patients with the first protocol, which was called MOMP-- M-O-M-P. And we had to do the workups ourselves. We couldn't use other colleagues to work up the patients. And we had to go get the patients ourselves. So Jack Moxley and I did all those things. And the results were very encouraging. And then Jack left. And I sat down and decided that we'd put procarbazine. I was working on procarbazine. It was then called [INAUDIBLE]. And I was working on it and doing the pharmacology in the phase I study with it in Hodgkin's disease. It was a promising candidate. So we put it in. And that became MOPP. Also in those days, six weeks of therapy was it. They didn't get more than six weeks. We reasoned that the marrow problems would be acute. But you'd have to give it probably for a long period of time to affect the tumor. So we gave it for at least six months or to a complete remission plus two months. And we assumed that there were cells left after we couldn't see them. So it was a lot of good thinking that went into it that turned out to be correct, because most of the-- since then, a lot of protocols follow the same sort of routine. And it really works for a lot of cancers. But it was controversial. I went to the AACR meeting. This was before ASCO. And I presented it as an abstract. And David Karnofsky, who was sort of a god at that time at Memorial Sloan Kettering, just tore me apart. And what was I doing using the term complete remission for a solid tumor. He said, that was a term that was used in leukemia. Now, I didn't say it. But I'm thinking, the reason you use them is you can get complete remission. So we had complete remissions. And I was kind of shaking with the microphone in my hand at the time. So it was a scary but it was a good experience. I have to say-- So it just gives you an idea that people were not receptive [INAUDIBLE]. Those of us who are junior to you can't imagine that you were intimidated by somebody else [LAUGHS]. Well, I was a youngster, then. I was-- Jack Moxley and I, I would say, thinking back, we were cocky. But the big guys in the field could scare me. And Zubrod was a-- I mean, Karnofsky was a big guy in the field. Yeah. He just had a hard time getting out of the leukemia mind frame. And so of course, we've used complete remission since then in any kind of solid tumor where you can get one. In your book, you have a great quote that you presented somewhere. And Dr. Frei was there. And Wayne Rundles was there. Wayne, of course, has been at Duke for 100 years. And he said, do your patients speak with you after you're done? Well, Wayne Rundles-- when he first saw the MOPP protocol, Wayne Rundles said, that's nonsense. He said, I get the same thing with nitrogen mustard by myself. Well, nobody had ever got that with nitrogen mustard. So we actually had to set up a controlled trial and do it and prove that MOPP was better. So when I presented it when we were first starting it-- at a meeting. Tom had arranged this meeting with all the bigwigs in the field. And when I presented it at that, everybody was sort of quiet. And then Wayne Rundles raised his hand. He looked pale. He raised his hand and said to me, Dr. DeVita, do your patients speak to you after you do this? [LAUGHS] So he-- a few years later when we were obviously getting good results, he invited me to grand rounds. And by then, we were good friends. And I was up on the podium. And after I gave the talk, he was sitting down below smiling at me. And I said, Dr. Rundles, if you remember, you asked me if your patients speak to you when you do this. And I can tell you that they do for a lot longer. So it was fun. But it was fun. He was a good friend by then. And I had great respect for him. Actually, he was a very nice man. He was. When did you start thinking that you had a success? Was it during those first 13 patients or 14 patients that you treated? I mean, was it obvious right away, or did you start [INAUDIBLE]-- Well, it was obvious-- --you were in the wrong place? We put-- no. We thought it pretty early, because we were worried. We put patients in reverse isolation. Nobody knew whether you were going to kill them if you gave them all these drugs together. And it turned out the first surprise was, yeah, they had the usual toxicity. But it really wasn't that bad. So it was doable. And the second was-- we had a small number. But we had-- something like 80% of the patients went into a complete remission. And I think nobody had seen that. Now, the question was, how long were they going to last? So we were optimistic. And when we put patients on it, there was no cure for them at that time. And we said, we're optimistic that this is going to be something that will last. But we don't know. And then by three years, it looked pretty good. And I think I presented the first abstract four years after we started. And by that time, we had relapse-free survival curves. And again, nobody before that time had presented relapse-free survival curves in any of the lymphomas. So by then, by four years, I think we felt we had probably cured some patients with the disease. I asked Bob Young this same question. Did you feel a sense of history at the time, that this was really historical? Or did that come later when you looked backwards? I think what people don't realize about those days is neither Freireich nor ourselves were treating leukemia and Hodgkin's disease. In other words, we weren't out to develop a treatment for those diseases. We were out to prove you could cure cancer with drugs, because nobody believed it. If you said that, they really thought you had gone balmy. So we were out to look-- so we knew if we could do it, it would be historic. So we were excited when we looked like maybe it was going to happen. By that time, when we had first reported it, the VAMP program that Freireich did, which was an historic program-- he only had 17 patients. And they actually never published a paper on VAMP. And I asked Jay why they never did that. And he said because he didn't think they would accept it anywhere. So but by that time, they were getting about a 50% complete remission rate going four or five years. And they were thinking they're curing leukemia. And we were getting 80% complete remission rates. So I think everybody felt that we were going to prove that you could cure cancer with the drugs. And we did. So yes, in a sense, we set out to do something that would be historic. And so when it happened, I think, it is. It was a sort of a door opener for medical oncology in Hodgkin's disease. I'd like to turn now for just a minute to your role in politics. You were pretty instrumental, I think, when the National Cancer Act was signed in 1971. And that also sounds like a TV drama to me. It sounds like-- and I know this anyway, but in reading your book, it was not clear that was going to get through. Can you give us some of the playground behind that and Mary Lasker's role and how that happened? Well, Mary Lasker played a big role. The MOPP program actually played a big role, because Mary Lasker was sort of working in the background. Cancer was always a cause for her. But when we did the MOPP program, there was a guy named Luke Quinn, who she had hired to be a lobbyist, who was sort of hidden in the American Cancer Society so they wouldn't realize it was Mary Laskers' lobbyist. And he was referred to me by Sidney Farber. And I didn't want to take him at first, because he was diagnosed as having gall bladder cancer. And I said to them, you know-- I said to Sidney Farber, I don't really treat patients with gall bladder cancer. And there was silence on the phone. And he said, (SOMBER, COMMANDING VOICE) you will take this patient. [LAUGHS] So I took the patient. And when I examined him, when he came down and I examined him, he had adenopathy in both axillae. And gall bladder cancer just doesn't do that. So I had to do another biopsy. He was not a pleasant guy. So it was not easy to do these things. I had to get another biopsy. And it turned out that my pathologist at the time, Costan Berard, when he compared the biopsy, he said, it's a lymphoma, clearly. It was a diffuse, large cell lymphoma. What they had done is, because Claude Welch did the surgery-- a very famous abdominal surgeon-- and he said it was gall bladder cancer, that the pathologist sort of assumed it was. And it was a compression artifact. Long story short, he went into remission. And Mary Lasker went gaga. Wait a minute. We got something here. And that was what pushed her to get her friend, Senator Ralph Yarborough, to put up a committee on cancer to come up with the Cancer Act. And-- So it must have been quite a day when President Nixon signed that. Yeah, well, it was-- I wasn't at the signing. I wasn't high enough up in the chain to be invited to the signing. But yeah, I have all the photos of him signing it. And later when I met him-- I have a picture in the book of he and I shaking hands and him looking like he's having a roaring laugh. People ask me what I said that was funny. And I have no idea. But when I asked him, I said what is your greatest achievement as a president? He said two-- opening up China and signing the Cancer Act. So he was-- Really? Yeah, so I think he was proud that he did that. That's a great story. Actually, the other story I had not heard, but read in your book-- I'd like you to tell me about your lunch with Mr. Featherstone. [LAUGHS] Featherstone Reid, his name was. Well, this was a very-- this was a regular occurrence. Mary Lasker, when she came to town, would stay with Deeda Blair, Mrs. William McCormick Blair, who was a Washington socialite and had a lovely house on Foxhall Road. And they would have lunches and dinners. And they always arranged it so that people-- the scientists sat next to somebody with influence. And this is how they influenced the Congress to put more money into the cancer program. So one time, I got a call in the morning from Deeda Blair, saying, I'm having a lunch. We'd like to have you there. And I said, gee, I-- it's too short notice. I can't do it. And she said, well, Mary really wants you to be there. Mary was hard to say no to. So I rearranged my schedule, drove down to Deeda's house. And there was a big black limo sitting in the front of the house. I went in, and they introduced me to Featherstone Reid. I had no idea who he was. And every time Mary would say, we want more money for research with leukemias and lymphomas. Vince, tell him about what's going on. And I would tell him about. At the end of the lunch, he left. And Mary and I sat down on the couch to have a cup of coffee. And I said, Mary, who is Featherstone Reid? And she said, he's Warren Magnuson's driver. And when she saw the shock on my face-- Senator Warren Magnuson was the chairman of the appropriations committee of the Senate. When she saw the shock on my face, she said, wait a minute. When Mrs. Maggie-- he takes Mrs. Maggie shopping during the day. And Mrs. Maggie-- he fills her with all this information we're giving him. And then Mrs. Maggie is the last person to put her head down on the pillow next to Warren Magnuson. This is the way she worked. She would take someone like Magnuson, who was a good friend, but she would surround him with extraneous people who would say the same thing. So it was sort of like subliminal stimulation for him. He was always hearing these positive things. And then he supported the program. She was a piece of work. I never got to meet her. But it sounds like she was a force of nature. She was. And of course, the Lasker Award is now named for her and her husband and sort of the American Nobel Prize. She's had such [INAUDIBLE]. Yeah, and our crew won it in 1972-- Frei, Freireich, myself, and other people for other things. So I'm very fond of Mary Lasker, obviously. It's just a wonderful story. And I got to know her pretty well, so. I have one other question. And I'm not sure you'll want-- if you don't want to go off on it, we can edit it out. But in your book, you talked about Howard Skipper and Frank Schabel. And Dr. Frei used to talk about them all the time. And I think it's worthwhile to bring them into the history of what we do. Did you actually work with them or collaborate with them, or just base some of your ideas on what they had in mind? When I was starting at the Cancer Institute, I thought Schabel worked at the Cancer Institute-- I mean, Skipper worked at the Cancer Institute, because I would be working in the lab. I was doing the tritiated thymidine studies on L1210 mice. And he would be looking over my shoulder. He was doing the similar studies, but he was just doing it with cell counts in the abdomen of the mice. And he thought that was good enough. And he was there at a weekly meeting we had, which George Canellos named the Society of Jabbering Idiots. It was a great, great meeting, actually. [LAUGHS] And he was there all the time. And my view and Tom's view differ a little bit on Skipper. I think he was a real driving force, that he did the studies in mice that we were doing in the clinic with people. And he actually-- in 1964, he wrote a paper showing that you could cure L1210 leukemia. It was the first example of curing a mouse with leukemia. And I think-- so it was sort of a feedback mechanism between the Cancer Institute and the Southern Research Institute. So and he did-- he used to do these booklets. And I think he published hundreds of these booklets. Some of them, we convinced him to actually publish as papers. But I have the collection. There may be 100 booklets he wrote. And he would take a concept that we were working on and then work through it in mice. It was very, very important. And he was a wonderful person. His only problem was he smoked like a chimney. But he was-- I liked Frank and Howard. Yeah, Dr. Frei had the entire set of monographs on his bookshelf in his office and would encourage us to come in and borrow them and read them and come back. And frankly, he basically predicted what you've done with combination therapy. He predicted adjuvant therapy working. There were just a number of things he saw in these mice that we've gone on to apply in the clinic. It's pretty remarkable, I think, so. Yeah, I mean, it's not only he predicted it. But he actually showed the concept worked in mice. So as we know, mice and human are very different [INAUDIBLE]. There was a guy in Boston, Stuart Schlossman, a very fine scientist. And he didn't like mouse models. And when asked what he would do when he saw a tumor-bearing mouse, he would say, I would step on it, because he didn't believe mouse models. And but Frank and Howard did experiments and made allowances for the difference between humans and mice. So it was always good to know. I mean, I have the summary he wrote on Hodgkin's disease after he saw the MOPP program. So I think they're very instructive booklets. So I kept them. Like Tom, I think that we sort of live by them. Well, thanks for discussing them. I think our listeners need to remember these two guys. They were great. We're running out of time. I've really just touched the surface of what you've done and contributed to the field. And the people you've trained is sort of a who's who of oncology, frankly. But at the end of the day, what's your-- I'll ask you the same question you asked President Nixon. And that is, what is your legacy? What do you want people to remember that Vince DeVita did? I get asked that question a lot. And I don't have one thing that I can say. I mean, I've been lucky in my career that I've had a chance to do many things. Being the Director of the Cancer Institute was wonderful. You could sit on top of the whole field and just sort of scan it and see what's going on. And it was very important, because you've become the spokesman of practicing physicians at the same time. MOPP, of course, was important. Putting out the first comprehensive textbook in the field and watching it-- we just came out with the 11th edition-- is also very exciting. So there-- we were the first to successfully treat Pneumocystis carinii pneumonia. And we reported it in a paper in the New England Journal. I mean, there were a lot of things. I'm best known, I think, for MOPP, probably, and the principles of MOP, which I'm very proud of. But there's so many that I have a hard time. I like opera. And people ask me, what's my favorite opera? And I usually say, it's the one I just saw. It's very hard for me to pick one opera. There's so many that I like. So I'm not dodging it. But I just never can say, well, it's this. That's very fair. Frankly, I think, without your contributions, I probably wouldn't be sitting here doing what I do. And I think there are thousands of us who would say that. So we're-- Well, that's very flattering. Well, not only are we appreciative, more importantly, there are a lot of people who are alive who wouldn't have been without what you and your colleagues did at the NCI that so many years ago, so-- [INTERPOSING VOICES] I was involved in the training of 93 medical oncologist. At one time, something like 40% of all the [INAUDIBLE] directors were our graduates. So they have gotten around. And that was good for the field. They went out with the same principles we were developing at the Cancer Institute, so that's very gratifying. Have you kept in touch with any of the patients that you're treated back at the NCI? I talked to Saul Rosenberg. And he told me he still sees people that he treated 30 or 40 years ago when he first moved to Stanford. We're writing a paper on the 45-year follow-up of the first 188 patients. Again, nobody has 45-year follow-ups. And we called every one of the survivors. And there's something like 60% or so of the complete remissions are alive. So I talked to some of them. But we had a nurse talk to a lot of them. And I got messages from them after the call. And some of them still contact me, after sort of an anniversary of their treatment. So yeah, I've kept up with them. The gratifying thing is most of them are suffering from the same illness as most people who are getting into their 70s or some of them 80s. They have hip problems and so on and prostate cancer. But there doesn't seem to be any really major increase in anything in these long survivors. Now, mind you, these were patients who got MOPP as their only treatment. And so when you see second tumors in these kinds of patients, it's usually patients who got radiation therapy plus MOPP. So these patients who are 45 years had just got MOPP. And they seem to be perfectly fine. That's remarkable. I love your comment that they are getting the same illness as the rest of us get as they get older. That's great. Yeah, we don't cure bad hips and bad knees and-- Yeah, we can't cure old age. When I was at the Dana-Farber, I had a patient who had been one of Sydney Farbor's original patients from the early '50s. And by this time he was obviously an adult. He was older than I was. And he was fine, as you've said. Although he said Dr. Farber kept treating him and treating him and treating him. And then finally, when Dr. Farber passed away, someone else picked up his chair. And they said, why are you still getting this? And they stopped it. Yeah. So he got a lot of treatment. I had one of Freireich's VAMP patients. She was a girl in her early teens. And she was a wildcat. But she had had something else, and it failed. And she was one of the first patients on VAMP. And she went into remission. And she stayed in remission. And I followed her for many years. She went to college. She got married. She had children. She brought her children in to see me. And last time I had any follow-up with her, she was in her 60s. And she was one of the really first long survivors of that particular program. So it's really neat to see these patients. And it's not rare for me to go to a meeting and have people walk up to me and say they got MOPP 25 years ago. Someone else gave it to them. And they're alive and well. So that's one of the great gifts of having a chance to do this kind of work. What a privilege. Well, I think we need to end. Again, I want to thank you for being on with us today and filling us in with some of these stories. Had really good feedback for my podcast series. And it's because of the people I've had on it. So thank you very much for all you've done. It's really good talking to you. And I look forward to listening to all your podcasts. [MUSIC PLAYING] Until next time, thank you for listening to this JCO's Cancer Stories, The Art of Oncology podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcast or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's Cancer Stories, The Art of Oncology podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org. [MUSIC PLAYING]

Dr. Baluch reviews the topic of invasive fungal infections (IFIs) in individuals who undergo hematopoietic stem cell transplantation (HCST). The author begins by reviewing risk factors for IFIs. She then discusses what constitutes an IFI. She differentiates infections caused by yeasts versus those due to molds, and discusses the assessment and management of invasive candida disease. Next, Dr. Baluch discusses non candida molds, including aspergillus, fusarium, and Mucor as well as atypical pathogens such as Pneumocystis. She closes with a discussion of antifungal therapy and what constitutes the ideal fungal agent.

Curbsiders’ Journal Club features rapid summary and critical appraisal of recent articles and news stories in internal medicine by The Curbsiders. This month’s topics include: asthma, maintenance versus as needed inhaler use, procalcitonin, Pneumocystis pneumonia prophylaxis, colon cancer screening, smoking cessation, cannabis and cognitive impairment, LDL cholesterol and mortality, plus some medical podcast recommendations. Over the last month, we have developed a list of more than 40 interesting articles and news stories that we have been feeding our own brain holes. From this list we have plucked a select few that we really wanted to highlight and share with you. Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Credits: Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Editor: Matthew Watto MD Time Stamps: 00:00 Announcements 00:20 Disclaimer 01:00 Intro to Curbsiders Journal Club 03:07 Mild asthma and as needed versus maintenance inhaler use 09:50 Smoking cessation, e-cigarettes, and financial incentives 17:23 Pneumocystis pneumonia prophylaxis 22:18 Cannabis and cognitive impairment 26:15 Colorectal cancer screening update by American Cancer Society 30:37 Procalcitonin for lower respiratory tract infections in the ED 37:29 Cholesterol, baseline LDL-C, mortality and cardiovascular events 41:01 Incorrect symbology and some podcast recommendations 46:22 Outro Tags: asthma, maintenance, inhaler, procalcitonin, Pneumocystis, pcp, pneumonia, prophylaxis, colon, cancer, screening, crc, smoking, cessation, marijuana, cannabis, cognitive impairment, LDL, cholesterol, mortality, cardiovascular, podcast, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

This week on The Rounds Table Andrew Smaggus and Paul Bunce are back with new evidence on the association between home care visits and same day emergency department use as well as antibiotics for pneumocystis pneumonia. The extent to which home care visits contribute to the delay or avoidance of ED visits has not been ...The post An Ounce of Prevention: Home Visits and ED Use & Septra Prophylaxis for Pneumocystis Pneumonia appeared first on Healthy Debate.

This week on The Rounds Table Andrew Smaggus and Paul Bunce are back with new evidence on the association between home care visits and same day emergency department use as well as antibiotics for pneumocystis pneumonia. The extent to which home care visits contribute to the delay or avoidance of ED visits has not been ... The post An Ounce of Prevention: Home Visits and ED Use & Septra Prophylaxis for Pneumocystis Pneumonia appeared first on Healthy Debate.

Dr. Pasikhova discusses the history of the Pneumocystis pathogen, its epidemiology, and how it is transmitted to patients. She also discusses the pathophysiology of the infection in the context of the immunocompromised cancer patient. The role of steroids in the aquisition of PJP infection is touched upon. Lastly, Dr. Pasikhova describes prophylaxis against Pneumocystis, including specific agents and their usual doses.

The TWiM team discusses the use of copper on exercise weights to reduce bacterial burden, and the mechanism of antigenic variation by which a fungus that causes severe pneumonia escapes the immune system. Hosts: Vincent Racaniello, Elio Schaechter, Michael Schmidt, and Michele Swanson Links for this episode: Reducing bacteria on exercise weights with copper (Am J Inf Contr) Antigenic variation in Pneumocystis jirovecii (mBio) Letters read on TWiM 165

Melanie Cushion holds down two jobs: she’s a research career scientist at the Veterans Administration Medical Center in Cincinnati, Ohio, and she’s also professor and associate chair for research in the department of internal medicine at the University of Cincinnati College of Medicine.  Dr. Cushion focuses her research on the fungus, Pneumocystis carinii, which is a harmless commensal for most people, but a deadly pathogen for others.  Pneumocystis carinii was shrouded in obscurity for many years until its fifteen minutes in the spotlight came in the 80’s, when, unfortunately, an outbreak of Pneumocystis pneumonia prefigured the AIDS epidemic.  Large numbers of previously healthy homosexual men in California became deathly ill with Pneumocystis pneumonia, and doctors knew something unusual (later found to be HIV) was going on.  Dr. Cushion says Pneumocystis pneumonia is an opportunistic infection: it strikes individuals with immune systems too weak to fend it off.  This explains why it was – and still is – a well-known sign that the patient is stricken with an active HIV infection or some other immune-suppressing disorder.  Dr. Cushion heads up the Pneumocystis genome project and she’s also looking into a new line of drugs called glucan synthase inhibitors, which have a profound effect on Pneumocystis’s life cycle and may offer new insights into managing the pathogen. In this interview, I talked with Dr. Cushion about some of the more surprising results to come out of her genomics work, why Pneumocystis is a tough nut to crack in the laboratory, and about why she’s not giving her young investigator award back to the Society of Protozoologists any time soon.

Objectives: There is scarce data on immune reconstitution in antiretroviral naïve AIDS-patients with toxoplasmosis. The observation of several cases with reduced increase of CD4-cells upon start of antiretroviral treatment (ART) prompted us to investigate the topic in the ClinSurv cohort. Methods: 17 German HIV treatment centers contribute to ClinSurv, a multicentre observational cohort under the auspices of the Robert Koch Institute. We retrospectively selected all antiretroviral-naïve patients with toxoplasmosis (Toxo) and - as comparator group - with pneumocystosis (PCP) between January 1999 and December 2005. Results: A total of 257 patients were included in the analysis, 61 with Toxo and 196 with PCP. Demographic baseline data showed differences with regard to gender, transmission group, and baseline CD4+ counts (60.9 vs. 44.7/µl, p=0.022). After ART initiation the increase in CD4+ lymphocytes was lower in the Toxo versus the PCP-group in the first, second and fourth three-month-period (74.4 vs. 120.3/µl, p=0.006; 96.6 vs. 136.2/µl, p=0.021; 156.5 vs. 211.5/µl, p=0.013). Viral load (VL) was higher in the PCP-group at baseline (4.46 log10cop/ml vs. 5.00 log10cop/ml, p=0.008), while virological success of ART was equal. Conclusions: Our data show for the first time that the average CD4+ T-cell increase of patients with toxoplasmosis is slower as compared to PCP. Most clinicians would not be prepared to discontinue follow-up Toxo-therapy unless CD4+ counts of 200/µl are reached. Explanation for our finding might be the myelosuppressive side effect of pyrimethamine, possible interactions of toxoplasmosis therapy with ART, or an unknown direct biological influence of toxoplasmosis on immune restoration.

Presented by Dr. Majid Sadigh in Kampala, Uganda as a part of the collaboration between Makerere University and Yale University

Wed, 1 Jan 1992 12:00:00 +0100 https://epub.ub.uni-muenchen.de/8176/1/8176.pdf Goebel, Frank-Detlef; Bogner, Johannes R.; Kronawitter, Ursula