Podcasts about Pseudomonas

TWiV reviews universal vaccine initiative at NIAID, shut down of the Integrated Research Facility at Ft. Detrick, modeling the reemergence of infectious diseases as vaccination rates drop, and bacterial outer membrane vesicles bound to bacteriophages modulate neutrophil responses to bacterial infection. Hosts: Vincent Racaniello, Alan Dove, and Jolene Ramsey Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode Support science education at MicrobeTV ASV 2025 Paul has Measles (YouTube, virology blog) Universal vaccine project (NIAID, CIDRAP) Measles update (US, Texas) Integrated Research Lab closed (Telegraph) Modeling reemergence of infectious diseases (JAMA) Outer membrane vesicles attached to phage (Front Cell Inf Micro) Pf phage review (Front Immunol) Letters read on TWiV 1215 Timestamps by Jolene Ramsey. Thanks! Weekly Picks Alan – A Paradise Built in Hell, by Rebecca Solnit (and here's my review of it) Jolene – Virology course student communication projects, Spring 2025 Vincent – Vaccine Education Center Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content in this podcast should not be construed as medical advice.

Matters Microbial #88: Microbial Interactions in Cystic Fibrosis April 24, 2025 Today, Dr. Reed Stubbendieck, Assistant Professor of Microbiology & Molecular Genetics at Oklahoma State University joins the #QualityQuorum to discuss how microbes and the host communicate with one another in the cystic fibrosis lung. Host: Mark O. Martin Guest: Reed Stubbendieck Subscribe: Apple Podcasts, Spotify Become a patron of Matters Microbial! Links for this episode An overview of cystic fibrosis as a disease with a genetic link. A review of the microbiome of the cystic fibrosis lung. An overview of biofilms. An interesting role for extracellular DNA itself as a “building block” of biofilms. An overview of polymicrobial communities. Life in mucus—an interesting essay. An overview of Pseudomonas aeruginosa. Pseudomonas and the siderophore pigment pyoverdin which is not only about iron, but also bacterial conflict and cooperation.   An interesting overview of microbe-microbe interactions, often called “sociomicrobiology,” and an introductory article on this topic. A review of the nasal microbiome. The organism Rothia, understudied and of interest to Dr. Stubbendieck's research group.  Some work from Dr. Stubbendieck's group describing how Rothia is helpful in inhibiting some disease causing bacteria. The organism Dolosigranulum pigrum, also understudied and of interest to Dr. Stubbendieck's research group. More work from Dr. Stubbendieck's group with another possibly probiotic bacterium,  Dolosigranulum pigrum, that may protect against disease causing microbes.  Dr. Stubbendieck's faculty website. Dr. Stubbendieck's very interesting research group website.  Intro music is by Reber Clark Send your questions and comments to mattersmicrobial@gmail.com

We're on a gram negative run! Join the Curious Clinicians as we learn: Why does Pseudomonas smell like grapes? Watch this episode on our new YouTube channel here, and read the show notes here! Click here to obtain AMA PRA Category 1 Credits™ (0.5 hours), Non-Physician Attendance (0.5 hours), or ABIM MOC Part 2 (0.5 hours). Audio edited by Clair Morgan of Nodderly.com. Medical student Giancarlo Buonomo is our producer. 

Water systems in nursing homes can harbor dangerous pathogens like Legionella and Pseudomonas, posing serious health risks to vulnerable residents. In today's webinar, we'll dive into waterborne threats and how facilities can strengthen infection prevention efforts to safeguard resident health. We're joined by Jennifer Brown, RN, BSN, CIC, Infection Preventionist and Quality Improvement Specialist at Quality Insights.Watch Video Recording Download Presentation SlidesDownload TranscriptCheck out our other interviews by visiting https://www.qualityinsights.org/ qin/multimedia This material was prepared by Quality Insights, a Quality Innovation Network - Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this mate rial do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number QIN-QIO-02/17/25-0161

Show notes at pharmacyjoe.com/episode1000. In this episode, I’ll discuss time to positivity as a predictor of catheter-related bacteremia and mortality in adults with Pseudomonas aeruginosa bloodstream infection. The post 1000: Should Pharmacists Be paying Attention to This Bacteremia Metric? appeared first on Pharmacy Joe.

Die Themen in den Wissensnachrichten: +++ Aktuell hohe Feinstaubwerte in Deutschland +++ Forschende bringen ein Bakterium mit Gentechnik zum Nylon-Fressen +++ Allergiker-freundliche Apfel-Sorte kommt im Herbst +++**********Weiterführende Quellen zu dieser Folge:Umweltbundesamt, 12.02.2025Upcycling of polyamides through chemical hydrolysis and engineered Pseudomonas putida, Nature Microbiology, 10.02.2025Lack of successful sexual reproduction suggests the irreversible parthenogenesis in a stick insect, Ecology, 29.01.2025Consumer responses to smoke-impacted pinot noir wine and the influence of label concepts on perception, ScienceDirect, Vol. 203. 2025**********Ihr könnt uns auch auf diesen Kanälen folgen: TikTok auf&ab , TikTok wie_geht und Instagram .

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.

Producer Giancarlo Buonomo is back! Join the Curious Clinicians as we learn: Why do we worry about Pseudomonas infection in diabetic patients? Watch this episode on our new YouTube channel here, and read the show notes here! Click here to obtain AMA PRA Category 1 Credits™ (0.5 hours), Non-Physician Attendance (0.5 hours), or ABIM MOC Part 2 (0.5 hours). Audio edited by Clair Morgan of Nodderly.com. Medical student Giancarlo Buonomo is our producer. 

On episode #72 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 1/2/25 – 1/15/25. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Human infection with a novel tickborne Orthonairovirus species in China(NEJM) Antiviral medications for treatment ofnonsevere influenza(JAMA Network: JAMA Internal Medicine)  Xofluza (GoodRx) NoroSTATData Table (CDC Norovirus) The discovery of the 27-nm Norwalk virus: an historic perspective (JID) Why the “Ferrari of viruses” is surging through the northern hemisphere (Science) Bacterial Beta-lactams toxicity in the intensive care unit: an underestimatedcollateral damage? (Microorganims) What is the most effective antibiotic monotherapy for severe Pseudomonas aeruginosa infection? (CMI: Clinical Microbiology and Infection) Doxycycline postexposure prophylaxis and bacterial sexually tansmitted infections among individuals using HIV preexposure prophylaxis(JAMA Network: JAMA Internal Medicine) Fungal The Last of US Season 2 (YouTube) Epidemiology and prognostic factors associated with mold-positive blood cultures: 10-year data From a french prospective surveillance program (2012–2022) (CID) Parasitic Safety and efficacy of immunization with a late-liver-stage attenuated malaria parasite (NEJM) Dr. Glaucomflecken explains: late-liver-stage attenuated malaria vaccine (YouTube) Dr. Glaucomflecken X NEJM (YouTube) Albendazole–ivermectin co-formulation for the treatment of Trichuris trichiura and other soil-transmitted helminths: a randomised phase 2/3 trial (LANCET: Infectious Diseases) Miscellaneous A comparison of peripherally insertedcentral catheter materials(NEJM) Considering Islamic frameworks to infectious disease prevention (OFID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

Guest: Dr. Christian de Virgilio is the Chair of the Department of Surgery at Harbor-UCLA Medical Center. He is also Co-Chair of the College of Applied Anatomy and a Professor of Surgery at UCLA's David Geffen School of Medicine. He completed his undergraduate degree in Biology at Loyola Marymount University and earned his medical degree from UCLA. He then completed his residency in General Surgery at UCLA-Harbor Medical Center followed by a fellowship in Vascular Surgery at the Mayo Clinic.   Resources:  Rutherford Chapters (10th ed.): 174, 175, 177, 178 Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/ The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext  KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/    Outline: Steal Syndrome Definition & Etiology Steal syndrome is an important complication of AV access creation, since access creation diverts arterial blood flow from the hand. Steal can be caused by multiple factors—arterial occlusive disease proximal or distal to the AV anastomosis, high flow through the fistula at the expense of distal arterial perfusion, and failure of the distal arterial networks to adapt to this decreased blood flow.  Incidence and Risk Factors The frequency of steal syndrome is 1.6-9%1,2, depending on the vessels and conduit choice Steal syndrome is more common with brachial and axillary artery-based accesses and nonautogenous conduits. Other risk factors for steal syndrome are peripheral vascular disease, coronary artery disease, diabetes, advanced age, female sex, larger outflow conduit, multiple prior permanent access procedures, and prior episodes of steal.3,4  Long-standing insulin-dependent diabetes causes both medial calcinosis and peripheral neuropathy, which limits arteries' ability to vasodilate and adjust to decreased blood flow. Patient Presentation, Symptoms, Grading Steal syndrome is diagnosed clinically.  Symptoms after AVG creation occurs within the first few days, since flow in prosthetic grafts tend to reach a maximum value very early after creation. Native AVFs take time to mature and flow will slowly increase overtime, leading to more insidious onset of symptoms that can take months or years. The patient should have a unilateral complaint in the extremity with the AV access. Symptoms of steal syndrome, in order of increasing severity, include nail changes, occasional tingling, extremity coolness, numbness in fingertips and hands, muscle weakness, rest pain, sensory and motor deficits, fingertip ulcerations, and tissue loss.  There could be a weakened radial pulse or weak Doppler signal on the affected side, and these will become stronger after compression of the AV outflow. Symptoms are graded on a scale specified by Society of Vascular Surgery (SVS) reporting standards:5  Workup Duplex ultrasound can be used to analyze flow volumes. A high flow volume (in autogenous accesses greater than 800 mL/min, in nonautogenous accesses greater than 1200 mL/min) signifies an outflow issue. The vein or graft is acting as a pressure sink and stealing blood from the distal artery. A low flow volume signifies an inflow issue, meaning that there is a proximal arterial lesion preventing blood from reaching the distal artery. Upper extremity angiogram can identify proximal arterial lesions. Prevention Create the AV access as distal as possible, in order to preserve arterial inflow to the hand and reduce the anastomosis size and outflow diameter.  SVS guidelines recommend a 4-6mm arteriotomy diameter to balance the need for sufficient access flow with the risk of steal. If a graft is necessary, tapered prosthetic grafts are sometimes used in patients with steal risk factors, using the smaller end of the graft placed at the arterial anastomosis, although this has not yet been proven to reduce the incidence of steal.  Indications for Treatment Intervention is recommended in lifestyle-limiting cases of Grade II and all Grade III steal cases. If left untreated, the natural history of steal syndrome can result in chronic limb ischemia, causing gangrene with loss of digits or limbs. Treatment Options Conservative management relies on observation and monitoring, as mild cases of steal syndrome may resolve spontaneously. Inflow stenosis can be treated with endovascular intervention (angioplasty with or without stent) Ligation is the simplest surgical treatment, and it results in loss of the AV access. This is preferred in patients with repetitive failed salvage attempts, venous hypertension, and poor prognoses. Flow limiting procedures can address high volumes through the AV access. Banding can be performed with surgical cutdown and placement of polypropylene sutures or a Dacron patch around the vein or graft. The Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) technique employs a percutaneous endoluminal balloon inflated at the AVF to ensure consistency in diameter while banding Plication is when a side-biting running stitch is used to narrow lumen of the vein near the anastomosis. A downside of flow-limiting procedures is that it is often difficult to determine how much to narrow the AV access, as these procedures carry a risk of outflow thrombosis. There are also surgical treatments focused on reroute arterial inflow. The distal revascularization and interval ligation (DRIL) procedure involves creation of a new bypass connecting arterial segments proximal and distal to the AV anastomosis, with ligation of the native artery between the AV anastomosis and the distal anastomosis of the bypass. Reversed saphenous vein with a diameter greater than 3mm is the preferred conduit. Arm vein or prosthetic grafts can be used if needed, but prosthetic material carries higher risk of thrombosis. The new arterial bypass creates a low resistance pathway that increases flow to distal arterial beds, and interval arterial ligation eliminates retrograde flow through the distal artery.  The major risk of this procedure is bypass thrombosis, which results in loss of native arterial flow and hand ischemia. Other drawbacks of DRIL include procedural difficulty with smaller arterial anastomoses, sacrifice of saphenous or arm veins, and decreased fistula flow. Another possible revision surgery is revision using distal inflow (RUDI). This procedure involves ligation of the fistula at the anastomosis and use of a conduit to connect the outflow vein to a distal artery. The selected distal artery can be the proximal radial or ulnar artery, depending on the preoperative duplex. The more dominant vessel should be spared, allowing for distal arterial beds to have uninterrupted antegrade perfusion. The nondominant vessel is used as distal inflow for the AV access. RUDI increases access length and decreases access diameter, resulting in increased resistance and lower flow volume through the fistula. Unlike DRIL, RUDI preserves native arterial flow.  Thrombosis of the conduit would put the fistula at risk, rather than the native artery.  The last surgical revision procedure for steal is proximalization of arterial inflow (PAI). In this procedure, the vein is ligated distal to the original anastomosis site and flow is re-established through the fistula with a PTFE interposition graft anastomosed end-to-side with the more proximal axillary artery and end-to-end with the distal vein. Similar to RUDI, PAI increases the length and decreases the diameter of the outflow conduit. Since the axillary artery has a larger diameter than the brachial artery, there is a less significant pressure drop across the arterial anastomosis site and less steal. PAI allows for preservation of native artery's continuity and does not require vein harvest.  Difficulties with PAI arise when deciding the length of the interposition graft to balance AV flow with distal arterial flow. 2. Ischemic Monomelic Neuropathy Definition Ischemic monomelic neuropathy (IMN) is a rare but serious form of steal that involves nerve ischemia. Severe sensorimotor dysfunction is experienced immediately after AV access creation. Etiology IMN affects blood flow to the nerves, but not the skin or muscles because peripheral nerve fibers are more vulnerable to ischemia. Incidence and Risk Factors IMN is very rare; it has an estimated incidence of 0.1-0.5% of AV access creations.6 IMN has only been reported in brachial artery-based accesses, since the brachial artery is the sole arterial inflow for distal arteries feeding all forearm nerves. IMN is associated with diabetes, peripheral vascular disease, and preexisting peripheral neuropathy that is associated with either of the conditions. Patient Presentation Symptoms usually present rapidly, within minutes to hours after AV access creation. The most common presenting symptom is severe, constant, and deep burning pain of the distal forearm and hand. Patients also report impairment of all sensation, weakness, and hand paralysis. Diagnosis of IMN can be delayed due to misattribution of symptoms to anesthetic blockade, postoperative pain, preexisting neuropathy, a heavily bandaged arm precluding neurologic examination. Treatment Treatment is immediate ligation of the AV access. Delay in treatment will quickly result in permanent sensorimotor loss.   3. Perigraft Seroma Definition A perigraft seroma is a sterile fluid collection surrounding a vascular prosthesis and is enclosed within a pseudomembrane. Etiology and Incidence Possible etiologies include: transudative movement of fluid through the graft material, serous fluid collection from traumatized connective tissues (especially the from higher adipose tissue content in the upper arm), inhibition of fibroblast growth with associated failure of the tissue to incorporate the graft, graft “wetting” or kinking during initial operation, increased flow rates, decreased hematocrit causing oncotic pressure difference, or allergy to graft material. Seromas most commonly form at anastomosis sites in the early postoperative period. Overall seroma incidence rates after AV graft placement range from 1.7–4% and are more common in grafts placed in the upper arm (compared to the forearm) and Dacron grafts (compared to PTFE grafts).7-9 Patient Presentation and Workup Physical exam can show a subcutaneous raised palpable fluid mass Seromas can be seen with ultrasound, but it is difficult to differentiate between the types of fluid around the graft (seroma vs. hematoma vs. abscess) Indications for Treatment Seromas can lead to wound dehiscence, pressure necrosis and erosion through skin, and loss of available puncture area for hemodialysis Persistent seromas can also serve as a nidus for infection. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines10 recommend a tailored approach to seroma management, with more aggressive surgical interventions being necessary for persistent, infected-appearing, or late-developing seromas.   Treatment The majority of early postoperative seromas are self-limited and tend to resolve on their own Persistent seromas have been treated using a variety of  methods-- incision and evacuation of seroma, complete excision and replacement of the entire graft, and primary bypass of the involved graft segment only. Graft replacement with new material and rerouting through a different tissue plane has a higher reported cure rate and lower rate of infection than aspiration alone.9     4. Infection Incidence and Etiology The reported incidence of infection ranges 4-20% in AVG, which is significantly higher than the rate of infection of 0.56-5% in AVF.11  Infection can occur at the time of access creation (earliest presentation), after cannulation for dialysis (later infection), or secondary to another infectious source. Infection can also further complicate a pre-existing access site issue such as infection of a hematoma, thrombosed pseudoaneurysm, or seroma. Skin flora from frequent dialysis cannulations result in common pathogens being Staphylococcus, Pseudomonas, or polymicrobial species. Staphylococcus and Pseudomonas are highly virulent and likely to cause anastomotic disruption. Patient Presentation and Workup Physical exam will reveal warmth, pain, swelling, erythema, induration, drainage, or pus. Occasionally, patients have nonspecific manifestations of fever or leukocytosis. Ultrasound can be used to screen for and determine the extent of graft involvement by the infection.   Treatments In AV fistulas: Localized infection can usually be managed with broad spectrum antibiotics.  If there are bleeding concerns or infection is seen near the anastomosis site, the fistula should be ligated and re-created in a clean field. In AV grafts: If infection is localized, partial graft excision is acceptable. Total graft excision is recommended if the infection is present throughout the entire graft, involves the anastomoses, occludes the access, or contains particularly virulent organisms Total graft excision may also be indicated if a patient develops recurrent bacteremia with no other infectious source identified. For graft excision, the venous end of the graft is removed and the vein is oversewn or ligated. If the arterial anastomosis is intact, a small cuff of the graft can be left behind and oversewn. If the arterial anastomosis is involved, the arterial wall must be debrided and ligation, reconstruction with autogenous patch angioplasty, or arterial bypass can be pursued. References   1. Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and Characteristics of Patients with Hand Ischemia after a Hemodialysis Access Procedure. J Surg Res. 1998;74(1):8-10. doi:10.1006/jsre.1997.5206 2. Ballard JL, Bunt TJ, Malone JM. Major complications of angioaccess surgery. Am J Surg. 1992;164(3):229-232. doi:10.1016/S0002-9610(05)81076-1 3. Valentine RJ, Bouch CW, Scott DJ, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg. 2002;36(2):351-356. doi:10.1067/mva.2002.125848 4. Malik J, Tuka V, Kasalova Z, et al. Understanding the Dialysis access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies. J Vasc Access. 2008;9(3):155-166. doi:10.1177/112972980800900301 5. Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-610. doi:10.1067/mva.2002.122025 6. Thermann F, Kornhuber M. Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review. J Vasc Access. 2011;12(2):113-119. doi:10.5301/JVA.2011.6365 7. Dauria DM, Dyk P, Garvin P. Incidence and Management of Seroma after Arteriovenous Graft Placement. J Am Coll Surg. 2006;203(4):506-511. doi:10.1016/j.jamcollsurg.2006.06.002 8. Gargiulo NJ, Veith FJ, Scher LA, Lipsitz EC, Suggs WD, Benros RM. Experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas. J Vasc Surg. 2008;48(1):216-217. doi:10.1016/j.jvs.2008.01.046 9. Blumenberg RM, Gelfand ML, Dale WA. Perigraft seromas complicating arterial grafts. Surgery. 1985;97(2):194-204. 10. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4):S1-S164. doi:10.1053/j.ajkd.2019.12.001 11. Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: Recognition and management. J Vasc Surg. 2008;48(5):S55-S80. doi:10.1016/j.jvs.2008.08.067

In this episode I talk about the cutting-edge world of bionic eye technology, diving into how devices like the Argus II Retinal Prosthesis are helping patients with retinitis pigmentosa and age-related macular degeneration regain rudimentary vision. Alongside this futuristic topic, I also reflect on the challenges of practicing in the ICU as a young intern and the complexities of addressing patient needs with innovative surgical techniques. Takeaways: Ophthalmology Subspecialties: Dr. Flannery provides an overview of the subspecialties within ophthalmology, from refractive and cornea surgery to retina, pediatric, and neuro-ophthalmology, highlighting their unique roles in patient care. The Power of Second Opinions: He emphasizes the importance of seeking a second opinion for high-cost treatments like LASIK or in-office dry eye therapies to make informed decisions about eye care. Foreign Bodies in Eyes: Dr. Flannery describes the tools and techniques he uses to remove foreign objects, from cat hair to rust rings, showcasing one of the more unusual aspects of his work. Sixth Nerve Palsy Case: He shares a compelling story about a young patient diagnosed with a cerebral venous sinus thrombosis, illustrating the importance of timely and accurate diagnoses in eye care. Safe Eye Drops Matter: He answers fan questions about redness-relieving drops like Lumify, advising against generics linked to dangerous Pseudomonas infections and explaining the benefits of trusted brands. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link:  Anatomy Warehouse Plus for 15% off use code: Glaucomflecken15 Today's episode is brought to you by DAX Copilot from Microsoft. DAX Copilot is your AI assistant for automating clinical documentation and workflows helping you be more efficient and reduce the administrative burdens that cause us to feel overwhelmed and burnt out. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode I cover a wide range of topics, including a detailed breakdown of the subspecialties in ophthalmology. From the most common fields like cataract and refractive surgery to the rare gems of neuro-ophthalmology and pediatric ophthalmology, I explain what each specialty focuses on and why some are harder to find than others. I also discuss the importance of getting a second opinion for high-cost treatments, share stories about removing foreign bodies like cat hair from patients' eyes, and recount a memorable case of sixth nerve palsy caused by a life-threatening cerebral venous sinus thrombosis. Takeaways: Ophthalmology Subspecialties: Dr. Flannery provides an overview of the subspecialties within ophthalmology, from refractive and cornea surgery to retina, pediatric, and neuro-ophthalmology, highlighting their unique roles in patient care. The Power of Second Opinions: He emphasizes the importance of seeking a second opinion for high-cost treatments like LASIK or in-office dry eye therapies to make informed decisions about eye care. Foreign Bodies in Eyes: Dr. Flannery describes the tools and techniques he uses to remove foreign objects, from cat hair to rust rings, showcasing one of the more unusual aspects of his work. Sixth Nerve Palsy Case: He shares a compelling story about a young patient diagnosed with a cerebral venous sinus thrombosis, illustrating the importance of timely and accurate diagnoses in eye care. Safe Eye Drops Matter: He answers fan questions about redness-relieving drops like Lumify, advising against generics linked to dangerous Pseudomonas infections and explaining the benefits of trusted brands. — To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – http://www.patreon.com/glaucomflecken Also, be sure to check out the newsletter: https://glaucomflecken.com/glauc-to-me/ If you are interested in buying a book from one of our guests, check them all out here: https://www.amazon.com/shop/dr.glaucomflecken If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link:  Anatomy Warehouse Plus for 15% off use code: Glaucomflecken15 Today's episode is brought to you by DAX Copilot from Microsoft. DAX Copilot is your AI assistant for automating clinical documentation and workflows helping you be more efficient and reduce the administrative burdens that cause us to feel overwhelmed and burnt out. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

On episode #70 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 12/5/24 – 12/18/24. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Epidemiology of Dengue— Puerto Rico, 2010–2024(CDC MMWR) Takeda Announces Voluntary Withdrawal of U.S. Biologics License Application (BLA) for Dengue Vaccine Candidate TAK-003(Takeda)  Global health and economic burden of chikungunya from 2011 to 2020 (BMJ Global Health) Bacterial Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis (JAMA Network) Say it ain't Steno: a microbiology nudge comment leads to less treatment of Stenotrophomonas maltophilia respiratory colonization(Infection Control & Hospital Epidemiology) Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults(JAMA Network) Epidemiology and Outcomes of Antibiotic De-escalation in Patients with Suspected Sepsis in US Hospitals (CID) Effectiveness of ceftazidime–avibactam versus ceftolozane–tazobactam for multidrug-resistant Pseudomonas aeruginosa infections in the USA (CACTUS): a multicentre, retrospective, observational study (LANCET Infectious Diseases) Bedaquiline Monotherapy for Multibacillary Leprosy (NEJM) Fungal The Last of US Season 2 (YouTube) Histoplasmosis Associated With Bat Guano Exposure in Cannabis Grower (OFID) Parasitic TWiV 1175: A hitchiker's guide to virology(microbeTV) Diverse RNA viruses of parasitic nematodes can elicit antibody responses in vertebrate hosts (Nature Microbiology) Neurocysticercosis school outbreak in Belgium (LANCET) Miscellaneous Maintenance of Certification: Is a Knowledge-Based Assessment Really Necessary? (CID) Living happily ever after? The hidden health risks of Disney princesses (BMJ) How to transport a polar bear, and other idiosyncrasies in providing emergency medical services in the Arctic (BMJ) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

The Daily Shower Thoughts podcast is produced by Klassic Studios. [Promo] Check out the Daily Dad Jokes podcast here: https://dailydadjokespodcast.com/ [Promo] The Daily Facts Podcast. Get smarter in less than 10 minutes a day. Pod links here Daily Facts website. [Promo] The Daily Life Pro Tips Podcast. Improve your life in less than 10 minutes a day. Pod links here Daily Life Pro Tips website. [Promo] Check out the Get Happy Headlines podcast by my friends, Stella and Mickey. It's a podcast dedicated to bringing you family friendly uplifting stories from around the world. Give it a listen, I know you will like it. Pod links here Get Happy Headlines website. Shower thoughts are sourced from reddit.com/r/showerthoughts Shower Thought credits: hacksoncode, Steinmetal4, LetMeExplainDis, MenInBlerg, Savage-Monkey2, Boatwhistle, wimpykidfan37, JonoProBono, Snoo_19146, SheriffColtPocatello, Ok-Software-1902, hearsdemons, natural1dave, OldTimeyMedicine, lionstigersbearsomar, Stock_Surfer, Tentmancer, TIFUstorytime, Sapphiregangster, , tuber_simulator, InfinityScientist, Pseudomonas_xx, Edawg661, dropkicked_eu, Terrible-Swim-6786 Podcast links: Spotify: https://open.spotify.com/show/3ZNciemLzVXc60uwnTRx2e Apple Podcasts: https://podcasts.apple.com/us/podcast/daily-shower-thoughts/id1634359309 Stitcher: https://www.stitcher.com/podcast/daily-dad-jokes/daily-shower-thoughts iHeart: https://iheart.com/podcast/99340139/ Amazon Music: https://music.amazon.com/podcasts/a5a434e9-da18-46a7-a434-0437ec49e1d2/daily-shower-thoughts Website: https://cms.megaphone.fm/channel/dailyshowerthoughts Social media links Facebook: https://www.facebook.com/DailyShowerThoughtsPodcast/ Twitter: https://twitter.com/DailyShowerPod Instagram: https://www.instagram.com/DailyShowerThoughtsPodcast/ TikTok: https://www.tiktok.com/@dailyshowerthoughtspod Learn more about your ad choices. Visit megaphone.fm/adchoices

On tomorrow's episode of The Wholesome Fertility Podcast, I welcome Dr. Sarah Wilson of @embracefertility. Dr. Sarah Wilson shares her personal journey with reproductive health and how she overcame challenges with her period and fertility. She emphasizes the importance of understanding one's own body and advocating for oneself in the medical system. Dr. Wilson discusses the role of the immune system and gut health in reproductive health, highlighting the connection between inflammation, gut bacteria, and hormonal balance. She explains how basic blood work can provide valuable insights into one's health and offers practical tips for addressing gut health issues. Dr. Sarah Wilson discusses the importance of gut health and its impact on overall well-being. She explains how the gut microbiome plays a crucial role in maintaining a healthy immune system and how imbalances in the microbiome can lead to various health issues. Dr. Wilson emphasizes the need to create a hospitable environment for beneficial bacteria to thrive and shares insights on the use of probiotics and spore-based organisms. Dr. Wilson provides practical tips for improving gut health, such as eating whole foods, avoiding processed foods, and managing stress.   Guest Bio:   On today's episode of The Wholesome Fertility Podcast, I welcome Dr. Sarah Wilson, ND. Dr. Sarah Wilson discusses the importance of gut health and its impact on overall well-being. She explains how the gut microbiome plays a crucial role in maintaining a healthy immune system and how imbalances in the microbiome can lead to various health issues. Dr. Wilson emphasizes the need to create a hospitable environment for beneficial bacteria to thrive and shares insights on the use of probiotics and spore-based organisms. Dr. Wilson provides practical tips for improving gut health, such as eating whole foods, avoiding processed foods, and managing stress.   Takeaways:   Advocate for yourself and seek answers when faced with reproductive health challenges. Understanding the role of the immune system and gut health is crucial for reproductive health. Basic blood work can provide valuable insights into one's health and help identify patterns and tendencies. Addressing gut health issues, such as inflammation and imbalances in gut bacteria, can positively impact reproductive health. Maintaining a healthy gut microbiome is essential for overall well-being and a strong immune system. Creating a hospitable environment for beneficial bacteria to thrive is crucial for gut health. The gut-brain connection and the enteric nervous system play a significant role in gut health. Managing stress, eating whole foods, and avoiding processed foods are important for improving gut health.       Dr. Sarah Wilson, ND, is the visionary founder of Advanced Women's Health, leading a healthcare revolution across Canada with clinics in Ontario and British Columbia. Overcoming her own health challenges, Sarah is dedicated to empowering women to reclaim their vitality naturally, merging research-backed expertise with her passion for Naturopathic Medicine. Beyond her professional pursuits, she is the Mom to two latino boys under 5 and is a self-proclaimed personal development and mindset fanatic.   www.advancedwomenshealth.ca Instagram: @embracefertility @drsarah_nd @advancedwomenshealthclinics https://www.youtube.com/@embracefertility https://www.linkedin.com/in/naomi-woolfson/     For more information about Michelle, visit: www.michelleoravitz.com   The Wholesome FertilityFacebook group is where you can find free resources and support:  https://www.facebook.com/groups/2149554308396504/   Instagram: @thewholesomelotusfertility   Facebook: https://www.facebook.com/thewholesomelotus/     Transcript:   Michelle (00:00) Welcome to the podcast, Dr. Wilson.   Sarah Wilson (00:02) Thank you so much for having me. I am so excited. I just really can't get enough of sharing all of the information that women need about reproductive health and empowerment. So thank you for having me.   Michelle (00:14) Love it. So I'd love for you to share your background and how you got into the work with reproductive health.   Sarah Wilson (00:21) It's such a huge conversation, I think such an important one because for so many of us, we get into it because we needed the medicine, right? And we explored that. So my story I always say is a really winding one. I was in and out of hospital my whole life until I was 18 and I was diagnosed with celiac disease, but I didn't fit the bill. And it was a naturopathic doctor that really pushed for that initial diagnosis. And so then, as we all do,   Michelle (00:28) Mm -hmm, yeah.   Mm -hmm.   Sarah Wilson (00:49) I avoided my calling and was trying to figure out how to recover and how to work within this and lost my period for almost five years. And so during this time, I was a researcher and I was seeing different naturopathic doctors. I was seeing different conventional doctors and specialists and people just kept saying they didn't know what was going on and they couldn't figure out why I was, like I wasn't exceptionally lean during much of that period of time. Like they just couldn't piece it together.   Michelle (00:58) wow.   Sarah Wilson (01:18) I had a doctor, think it was 21, 22, that was like, you might never have kids on your own. If you wanna get pregnant, come back to me, I'll give you a pill, we'll wish you the best.   Michelle (01:28) So nonchalant.   Sarah Wilson (01:31) And I just, I always say there's a few breakdown to breakthrough moments in my life and that was a big one where I was just like, absolutely not. I have the world available to me. I have all of this research. There must be something I can figure out. So that proceeded to really get me to push to work and find the research and piece things together. And I did bring back my period. And then when it came back, it was exceptionally painful. I was passing out. I had been on birth control.   Michelle (01:37) Mm -hmm. Yeah, good.   Mm -hmm.   Sarah Wilson (02:00) since I was 13 because of the amount of pain and heaviness. And so that's what it was like, okay, now we have to navigate this world of endometriosis and what that means. so yeah, now fast all the way forward, I became an astrophysicist doctor. I have two babies with two tries. I do not live in chronic pain and I'm just so passionate about taking all that research. I had to figure out myself and...   Michelle (02:09) Mm   Mm   Mm   Sarah Wilson (02:26) had to bring into practice and navigate how to bring into practice to now be able to give that to patients across advanced women's health clinics in Canada. it's just, it's a very empowering end to a really challenging journey, which I think so many people listening have.   Michelle (02:44) Yeah, for sure. What I love about what you were saying is that knowing that inner knowing you're like, no, absolutely not. Like you knew it in your heart. Because a lot of people hear that. And then they're like, okay, I guess that's just my fate. And I love, you know, I love when people are like, no, I'm gonna take no for an answer. I'm gonna figure it out. and it's also an intuition. It's like your own intelligence within you telling you, no, there's more to look into. I had a similar   thing a little different, but similar. so what was it, let's kind of go back just because people might be in similar situations with their period, listening to this. What was it that really caused the five years without period? was it being on a pill for a long time? What was it that caused that?   Sarah Wilson (03:29) So I was actually, my presentation of celiac disease was very different. I was 100 pounds heavier than I am now. I perfectly, I exercised and I was obese. And so what, the brain is such a beautiful thing. And what I believe happened is that being obese, going through puberty programmed my brain for what body fatness, quote unquote, I needed to have in order to be safe to have a baby.   Michelle (03:36) Mm   Mm   Mm -hmm.   Mm -hmm.   Sarah Wilson (03:59) And so for most people, they lose their periods around 16, 18 % body fat. I tend to hover around 23, 24. If I dip below that, then my period starts to go as long, it goes wonky. It's much better now, but the research suggests that when you have inflammation interacting with your brain, when you have cortisol interacting with your brain, what happens is we actually change how sensitive we are to the signals between the brain and the ovaries.   Michelle (04:08) Mm   Mm   Sarah Wilson (04:28) And so I think that in combination with all these set point theories, there's so many things happening now in the world of set points, that combination is what it was. So for me, getting my inflammation under control, which we'll talk about, getting an understanding that I had stress, but it was physiological stress. I had nutrient deficiencies, I had bacterial overgrows, I had inflammation, like I had all of those pieces.   that were interacting with my brain and my hormones. And so I just needed to go through step by step. I needed to work on my gut microbiome. I needed to work on the nervous system component. But fundamentally, I needed to understand that my body, the way it works and its sensitivity is set at a slightly different point than other people's.   Michelle (05:18) Yeah, well, for sure. I mean, I think that that's really at the crux of everything is that everybody has their own different set point and different like, you know, responses, their bodies respond to different foods, different environments, different stress factors, just so many things. And I think that that's the key. I often see a lot of people sometimes come in to see me and they're well, I'm taking this kind of like,   combination herbs that I saw online or, you know, so, that's, that's one of the things that I really try to stress to people is that everybody's so different. And so when you were going through that, you were uncovering it. Obviously you had a natural path that you were working with. Yeah, multiple. So they, you had a team.   Sarah Wilson (05:58) And multiple. Yeah, absolutely. And I think I always say I'm the most energetic scientist you'll ever meet in your whole life. Like data informs every single decision. And then you sit in front of the person in front of you and you say, OK, what's their energy? Right. Like what? How do you need to to build those things together? And so, yeah, I had a team I had.   Michelle (06:09) Mm   Mm right. Totally.   Sarah Wilson (06:23) And I had multiple naturopathic doctors try to work their way through it. I had OB -GYNs and my family healthcare team trying to help navigate it. And it was just, I was in the typical situation. I was in the situation that 90 % of my patients are in. Everyone's like, you're fine. It's fine. Your blood work is fine. Right? And that's, think, even for me doing research, one of the projects I was on was we were studying metabolically healthy people, metabolically unhealthy people.   Michelle (06:41) Right, exactly. Yeah.   Sarah Wilson (06:52) We were studying them in lean and obese categories. And so the labs going through and they're pulling all this data. And it was the first time that I'm sitting there going, huh, okay. So we can have people that are metabolically very healthy and overweight. And we can have people that are very lean and extremely metabolically unhealthy. And this was, it was such a formative experience because I remember sitting there going.   Michelle (06:55) Mm   Mm -hmm, right.   Sarah Wilson (07:20) The blood work, the way we're reading it right now means nothing. Right? Like we need to be rude.   Michelle (07:25) There's so much more. It's just a snapshot. It's like a small, it's a small little slice. And I think that's something that I often see too, is that we make such generalized assumptions based on such a small little snapshot. And while that snapshot is very important, it's, it's kind of a piece to the puzzle. It's not the end all be all it's part of the whole picture.   Sarah Wilson (07:28) Exactly.   Exactly, and if we use a conventional reference range that's defined based on disease, like I think in North America, we've really lost the understanding that there's a line between health and disease. Like you don't just jump from one to the other like long jump, right? It's not like I'm healthy today and tomorrow I have a disease. Like there's this spectrum of dis -ease as we make our way to a condition. And I think identifying patterns in labs.   and identifying tendencies is arguably more important than the snapshot itself, you're 100 % correct. And so we have to look at that data holistically and say, how is that changing? How is that modifying over time? But also I think there's so much research now where we can give people back the keys to the castle with that basic blood work, right? Even for example, everyone has had what we call a complete blood count. We've had multiple of them. So that's...   A complete blood count is when we're looking at your red blood cells and your white blood cells. We're looking at the breakdown of those things. It's the thing you get when you walk into the doctor's office, when you get when you walk into the hospital, et cetera. They're always just saying, what's your white blood cells? What's your red blood cells doing, et cetera. And there's two white blood cells called neutrophils and lymphocytes. They are just representing two aspects of our immune system that are fighting bacteria and viruses and they're helping to support the system.   But there is a ton of research coming out to show that the ratio between neutrophil and lymphocytes can tell us about the inflammatory status of the body. So if your NLR, as we call it, neutrophil to lymphocyte ratio, is higher than 2 .5 or 3, chances are you've got an immunological underpinning to what's going on. And so for me with endometriosis, I was in the hospital a while ago now, and I was having a flare, and I was worried about ovarian torsion, because at one point I had had a 10 centimeter endometrial.   Michelle (09:30) Mm -hmm.   Sarah Wilson (09:40) like it was very, very large and it's not there now, but I just wanted to go in and make sure that there wasn't something happening because it felt different. And my NLR was six, but outside of that, it was one or two. So this is something I always say to patients, you can even empower yourself just looking at that number and being like, if that number is jumping high and it's correlating with my symptoms, if I have worse menstrual pain or worse mood challenges or   Michelle (09:42) Mm -hmm.   Mm   Mm   Mm -hmm.   Sarah Wilson (10:08) I get pregnant and these things jump and then I have a loss, what could that be telling you about your immune system? And I think there's such simple things. Of course, we can run super comprehensive panels of labs and get all of the autoimmune tests. And like I've heard you talk about them on the podcast before, right? You can get really comprehensive panels and that's wonderful. And I love that as a doctor and a researcher, I love data. But what I love even more is saying, let's look at the past two or three years.   Michelle (10:26) Mm   Mm   Right.   Sarah Wilson (10:37) What are these basic blood markers telling us about your tendencies and how much we need to dig into different components of health, like your immune system, your blood sugar, those types of things?   Michelle (10:48) So you could see this basically on just general blood work.   Sarah Wilson (10:53) Exactly. And so that's where I think for me.   Michelle (10:55) And do people often look like, do doctors even know to look for that specific thing? So it's kind of one of those things that people don't really look for, but you can kind of dig up your own stuff and just look at the ratio yourself.   Sarah Wilson (11:07) Exactly. Exactly. And that's why I think I come on these podcasts and I do these things because not everyone has access to a naturopathic doctor. Not everyone can be a researcher. Exactly. So to be able to look at that and start to question, even when I was in the hospital, I was like, are you concerned about that? And they're like, maybe you have a bacterial infection. It's not a big deal. Okay. Okay. Right? But it's...   Michelle (11:16) Yeah, that's very empowering.   Mm -hmm. Yeah.   Sarah Wilson (11:30) It's those things that I want people to be able to grab onto and access for themselves because what I know to be true in my practice, seeing so many people, is when you give women access to information about their bodies, they change communities, households, everything. Like it is the most empowering thing for me to come on a podcast and talk about something and then...   Michelle (11:46) Mm   Yeah.   Sarah Wilson (11:57) get someone message me and be like, my friend of a friend of a friend told me to look at this and now I'm concerned about it. And I'm like, yeah, you should probably get that investigated. And then it's ovarian cancer. You know what I mean? Like this is how powerful just these conversations are.   Michelle (12:08) my God, yeah.   Yeah, it's very powerful. mean, obviously when you do see that something's off, it'll get you at least to take the next steps or to investigate it more because you can't really make, you know that something's going on, but you have to like really move further and see what it is. But at least it's going to be an alarm to let you know something's going on.   Sarah Wilson (12:35) Mmm.   And a direction, right? I, every day, pretty much at this point, I'm talking to someone who's like, everything I was told was unexplained, right? And in the fertility world, if you're unexplained infertility, you either have a baby or you don't, right? So there's clarity in that, no one's saying, your infertility is in your head. But in every other aspect, there's not those clear end points. And so,   Michelle (12:40) Mm   Mm -hmm.   Mm   Sarah Wilson (13:07) if someone's dealing with chronic pain and they aren't getting investigated for endometriosis or some other condition, they can be told it's all in their head. So even if they can see on basic blood work, one or two things that are off, it's like, there, go there, let's do this. And I think that's what's so exciting to me.   Michelle (13:24) Mm -hmm. Right, right.   Yeah, definitely huge. So talk about the immune system. this is one of the things that you can look at, I know that there is a lot of a connection with autoimmune conditions and the gut health and, high inflammation and leaky gut. So talk about that, how people can look into it and how they can address it.   Sarah Wilson (13:53) Absolutely. So I actually also was a microbiome researcher at one point in my profession. It's so important. And even now, like post pandemic, we've seen it so much more important because historically, what do we always say? Is 60 to 80 % of your immune system lives in your gut. Okay. So there is within your gut, there is, it's so interesting. Picture a PVC pipe, right? On the inside, if there's Play -Doh.   Michelle (13:59) awesome. Amazing, though, but it's so important.   Mm   Mm   Sarah Wilson (14:23) that's where the bacteria live, right? But that's actually outside of your body. And so that play -doh is either poop, in those of us who are lovingly chronically constipated, or it's the mucosal lining that the bacteria live within. So that's where the immune system is really, really critical, is within that putty lining. And so what happens is that immune system's job, because it's technically outside of your body, mouth.   Michelle (14:26) Mm   Mm   Sarah Wilson (14:51) all the way down to your anus is outside of your body. Its whole job is to say, are you a food and you're safe? Are you a bacteria and you're safe? Are you a virus and you're not safe? Are you a bacteria and you're not safe? And the whole job of that immune system is to sample and navigate. Do I need to kick off an inflammatory response or do I not? Am I safe or am I not? And so what we're looking at is when we start to have allergies.   and we start to have food responses and all these food sensitivities when we start to have bloating and gas changes in bowel movements. That's all telling us that our immune system either one has identified a bacteria or virus that needs to go and it's kicking off a response to it or two, it has what we call lost oral tolerance. It has lost the ability to know between what's good and what's bad.   Michelle (15:46) Mm.   Sarah Wilson (15:47) And so in both of those situations, that is going to result in inflammation, not just local to our gut, but throughout what we call our peritoneal cavity, right? So that's gonna be your ovaries. I always say, your bowel and your ovaries and your uterus are friends. Like for those of you who can't see it, they're touching, they're friends. So we have that inflammation in our reproductive system. We have that inflammation affecting our liver.   then it goes into our bloodstream. It affects our joints, it affects our brain. That's why we talk so much about the gut brain connection, because there's that inflammation there. But as a practitioner, my job is to sit here and say, is it that we have so much inflammation? There is this absence of an ability to regulate, should I fight this or should I not?   Is it that there's so much damage being caused by inflammation that now we have leaky gut or impermeability, right? Because the immune system will cause damage and it's trying to fight something and there's collateral damage. So is it that or is it that there's bacteria that need to be modified? And so I think it's really helpful, even like thought experiment to think about it in that way, because so much of the time when it comes to the gut, we   Michelle (16:43) Mm   Mm   Sarah Wilson (17:05) are assuming that our symptoms are wrong. Like, what's wrong with my gut? Right? Like, we're a victim to it. Like, our immune system is doing something bad. But nine times out of 10, it's trying its best to protect us. And so our job is to say, what is it protecting you against?   Michelle (17:08) Mm -hmm. Right.   Mm   Mm   Right.   Sarah Wilson (17:25) So when we're navigating and we're going through then, we hear all about probiotics and we hear all about these different things and all of them can be helpful and have their place, right? We hear about armor colostrum all the time these days on different podcasts, right? We hear about all these things. And so I always say, think about them and put them in the context of what I just said. So if we don't have enough good bugs and we add probiotics, which are good bugs,   Michelle (17:36) Mm   Mm right, yeah.   Sarah Wilson (17:52) then that will take us so far. for, again, for those of you who can't see, I've got my hands up, right? Picture it like a bar graph. So if you don't have enough good bugs and that bar is low and you have too many bad bugs, then the dominant state is bad bugs. So if you add a whole bunch of good bugs, then eventually you can turn that dominant state into good bugs. But probiotics are transient, they leave the system. So you still have that low grade bad bug situation.   Michelle (18:06) Mm   Sarah Wilson (18:21) So this is where we hear about berberine, right? We hear about oregano, we hear about black cumin seed, we're hearing so much about all of these herbs now, because what they're doing is they're breaking down the bad bugs to allow the good bugs to grow, to repair the lining. it's, there's such a huge dance with the bugs in the gut and the immune system and how that affects the rest of your body, but what we know for darn sure is that   Michelle (18:23) Mm   Right.   Right.   Sarah Wilson (18:49) There are overgrowths that are happening more than they ever have been before of bad bugs. We know that.   Michelle (18:55) Right. So we're talking about things like SIBO, you know, just that, because that ultimately it starts to kind of go from like the bowels all the way up.   Sarah Wilson (19:04) Yeah, exactly. So SIBO is small intestinal bacterial overgrowth. So it's overgrowth of good bugs in the small intestine. We also have what we call CFO or overgrowth of yeast in the small intestine because the immune system can't defend against the yeast. Then we have bad bugs and parasites, right? So this is where we hear an overgrowth of, I'll throw some names, like Pseudomonas, C. difficile, Clostridium species, E. coli. We have an overgrowth of bad bugs in that situation. And those can be   Michelle (19:11) Mm   Mm   Mm   Mm -hmm. Bye.   Mm   Sarah Wilson (19:34) upper but they can also be lower down. And so that's always what we're navigating is saying, okay, is there, if you have an overgrowth of good bacteria and you add more good bacteria, you're gonna be the person who feels awful on probiotics. You take them, you're gassy, you're distended, okay, in that, yeah.   Michelle (19:49) Right.   Unless, unless they're spore based.   Sarah Wilson (19:56) The SBOs are such an interesting conversation. They're such an interesting conversation because most of the research is coming out of two labs. And so I agree to some extent and I'm pensive. Yeah.   Michelle (19:59) Yeah.   Mm -hmm.   Okay. No, tell me, tell me. I want to hear it because, because I've always been told and I've always learned that spore -based probiotics, because, they, they bypass the small intestine, they go all the way down to, you know, the colon that, and then they, and then they flourish and they change the pH and they, they make it so that it's more hospitable for the good bacteria to grow and not the bad bacteria. A lot of times there's like die -off symptoms and it   Sarah Wilson (20:32) Exactly.   Michelle (20:36) kind of shifts, even though it's transient, it does shift the pH to create it where it's better for a healthier environment.   Sarah Wilson (20:47) Absolutely. So it's just like that bar graph, right? I always say if you give the environment for the good bugs to grow and there's not too many bad ones, then they will grow and take over. If you ever, I always tell people picture like an octopus or a cuttlefish, you know they change colors really rapidly? Our bacteria do the same thing. It's called quorum sensing. And so essentially if you create a hospitalable environment, you have enough mucus. This is the other thing, right? Bacteria need mucus.   Michelle (20:49) Mm   Yeah.   Yeah.   Mm -hmm. Yeah. Mm -hmm.   Mm The mucosal lining. Yeah.   Sarah Wilson (21:13) Exactly. So if you have that integrity, you add probiotics, and then you can change from a red environment, inflamed, the pH is off, there's bad bugs growing to a good environment. If you don't have that mucosal lining, if your immune system is too grumpy, or if you're in a situation where there's too many bad bugs, then you can't fix it by adding more.   Michelle (21:17) Mm -hmm.   Mm   Mm   Mm   Sarah Wilson (21:40) And so that's where we're using antibiotics and antimicrobial herbs and things like that to get that down. Going back to the SBOs, the thing I find really interesting is there's so many, I could like nerd out on this stuff all day long as you can tell, but there's so many factors, right? So when we talk about it bypasses the small intestine, what they mean in that situation is that all bugs are either acid sensitive, temperature sensitive,   Michelle (21:54) It's great stuff though.   Sarah Wilson (22:09) oxygen sensitive or yeah, I went through acid. Those are honestly the main ones. There's nitrogen sensitive, things like that, but those are the main ones. So what they're saying is the acid sensitivity means that they will get, and the temperature and oxygen sensitivity means they're gonna get lower down. But what we're seeing more and more and more is that people's stomach acid is off, their pH is off throughout their whole system. They have all kinds of,   Michelle (22:32) Mm   Sarah Wilson (22:37) you know, temperature sensitivity changes. And we have all kinds of changes in the hydrogen, methane and oxygen levels within our gastrointestinal tract. So what happens is we're not actually controlling where it's going. We're controlling at what environment it takes hold. And because there's so much dysfunction within the gastrointestinal tract in so many of our patients, I'm concerned that it actually could take hold.   and be present at higher levels of the gastrointestinal tract contributing to issues. And I've seen some... Yeah, that's BOs. Yeah.   Michelle (23:10) You mean the spore based ones, the spore based? you, because from what I understand, looking into it is that it won't activate until it gets to the large intestine.   Sarah Wilson (23:23) And that's based on the pH, the oxygen level and the temperature and all of those pieces.   Michelle (23:29) Okay, I see. So you're saying that it could be a different pH and everything will shift if things are so off, up, you know, higher. Got it.   Sarah Wilson (23:36) Exactly.   Exactly. And I've seen severe constipation in patients that take SBOs. It's like the only side effect I see, because you're right, there is a lot less bloating gas, those like three to five day battle between the good and the bad bugs. There's less of that for sure. But I have seen like enough patients that got me saying, okay, what's going on there that take it.   Michelle (23:47) Mm   Mm -hmm. Mm -hmm. Yeah.   Mm   Sarah Wilson (24:04) and immediately they're super constipated. So we actually use them a lot in diarrhea because of the benefit of that. But it's definitely a space I'm watching the research. It's super interesting. I think just like, so I was, my God, how many years ago now was I a probiotic researcher? least 10. It's a different world, right? Like how exactly, so.   Michelle (24:10) Mm -hmm.   Yeah.   Mm -hmm. yeah, they're learning so much so fast. Yeah.   Sarah Wilson (24:30) Exactly. So that's where I always say, you know, you're a good practitioner when you want to refund everyone every five years. You're like, what was I doing? So I think it's just an evolving conversation, but they definitely do have utility for sure. I think there's just, for me, just having been in a research environment, I know how controlled all of those situations are. And so then when they come out into our patient situations,   Michelle (24:35) Yeah.   Yeah.   Sarah Wilson (24:56) We just need to apply different lenses of thought to it.   Michelle (25:01) Or I mean, you can also add something like Trifola while they're doing that so that you're kind of like counteracting the constipation aspect or maybe some more fiber eventually when they're ready, you know, because sometimes too much of that when things are not great can exacerbate.   Sarah Wilson (25:17) Absolutely. And like we have studies now that are coming out to show that it's alarming. Over 50 % of people have what we call retained fecal matter, which is like constipation when they don't know constipation. And so I think there's so much that we're finding out and there's so much that's going on within the gut microbiome world that will be.   Again, I'm just always so curious to see where it goes and to see what happens with it. Because even I wrote a book in 2018, I guess. So I was writing in 2017 on insulin resistance and how that worked. And like I talked about in Cretins in a big section of that book. This was like pre -Ozempic days. And people at that point were like, what is she talking about? And now it's so accepted. And that's what six years later, right? They're just like, of course.   Michelle (26:08) Yeah.   Sarah Wilson (26:11) So, so much changes so quickly. And I think just staying on top of it is something I value so much. Like even today, I'm teaching an intensive on post -viral immunology for other practitioners, right? So, I'm always trying to navigate what do I see in practice? Because we see thousands of people in advanced women's health. And how is that showing up in the research? And how do we mesh those things and adapt with those things? Because things change so quickly.   Michelle (26:14) Yeah, for sure.   Mm   yeah, definitely. No, I agree. mean, everything just kind of out does itself. Something new comes along. what I find really fascinating is the gut brain relationship and the enteric nervous system and also the vagus nerve and how that impacts. It's kind of like the go between our brain and our gut. And, and also   Sarah Wilson (26:50) Yeah.   Michelle (27:01) the research on that where they've done like studies on meditators and like people in Tibet, Tibetan Buddhists, compared to people that are neighbors that eat the same food, they live in the same environment, but the gut microbiome of the meditators is so much more enriched. So it's kind of like a buy between, yes, we could work from the gut to the brain, then we can also work from the brain to the gut. And it's pretty fascinating.   Sarah Wilson (27:12) Yeah. Yeah.   Absolutely, and even to see the amount of research on people's levels and how that is directly related to yeast infections. We know that that whole gastrointestinal tract, vaginal microbiome, they are so, so, so closely tied to our nervous system and stress response. There's so much, I do.   Michelle (27:34) Mm   Mm That's interesting.   Yeah.   Sarah Wilson (27:52) stool testing on myself pretty frequently. I would say even more so than patients, I do it on my family. And it's so interesting to see how it shifts because again, diet and lifestyle can stay very similar. So it's like interesting what caused that shift, what caused that shift, how was stress involved with these things. it's, yeah, it's so fun. It's so fun.   Michelle (27:58) Yeah.   Mm -hmm.   Yeah, it's fascinating for sure. And then also, think about the gut microbiome, I think about the changes, I think about inflammation. I think about the additives we're eating and we're exposed to. mean, those are the biggest things because it feels like it's outside of our control. I mean, it kind of is until we know about it. It's, know, we go eat some places, we have no idea what they're adding and we know that   Sarah Wilson (28:33) Mm   Michelle (28:40) thickeners, I mean, there's so many things that can be added. We know that they can really throw off the gut microbiome and that throws off inflammation. So it's kind of like an unintended consequence because you're not, most of us don't know that unless we're doing what we're doing and learn about it.   Sarah Wilson (29:00) And then you're looking, is there SLS in this? Is this disrupting my microbiome?   Michelle (29:04) Yeah, but that's what it is. And that's why when people say, I guess, to simplify it is just don't eat processed food as much as, try to avoid it as much as possible. Because even like the good kind can impact your gut. mean, like good processed food, because of all of the excess ingredients that they add in there, that could really throw off your microbiome. That's why when people say just, I guess, like, if you want to say something that's more generalized, is more whole foods, foods that come from the   earth and also foods that are not sprayed with toxins, know, I mean, to try to avoid it. It does feel like an uphill battle.   Sarah Wilson (29:44) Patients are so overwhelmed, right? It's you're trying to eat whole foods and then you look and they're like, okay, well, what about genetically modified agents? And then what about what's being sprayed on them? And I always say that in of itself is a stress response, right? So we talk about stress and then we make food such a stress. And so I always say to people, the reality is that you could probably do better than you're doing right now.   Michelle (29:45) Yeah.   Sarah Wilson (30:12) and what feels reasonable, what doesn't feel overwhelming, right? And we'll actually sit there and go through and say, okay, I need you to eat a low insulin demand approach, because insulin is such a huge inflammatory compound. Insulin is the hormone that controls blood sugar, but it's like 75 plus percent of us are insulin resistant in today's day and age. So it's a huge, it's an epidemic. So I'm like, okay, don't eat a ton of carbohydrates,   Michelle (30:14) Mm   Yeah. Yeah.   Sarah Wilson (30:43) I hate good carbs, bad carbs, but berries, all of those highly colorful fruits and vegetables, don't count them. Eat away, enjoy your life. I'm not talking about that. We all know we shouldn't eat as much bread. Deep fried foods are not helping anyone, right? The starchy carbohydrates, rice, like that. We have to watch those things. We built a culture on creating addiction to carbohydrates. So we have to be careful of those things. But it's like, how can you add two servings of vegetables? If you can...   Michelle (30:52) Yeah.   Nope.   True.   Sarah Wilson (31:12) buy local and you know where they're coming from, rock on. Like it's summer here right now. There's farms that I know do not spray anything, but they cannot certify organic because they can't afford it. Okay, wonderful. I can go there, right? Buy frozen organic. It is pretty much the same price to buy frozen organic as it is to buy broccoli right now, right? And saves my life prepping it. It is picked right.   Michelle (31:26) Yeah.   Mm -hmm. 100%.   Yeah.   Sarah Wilson (31:41) It is frozen right away. There's benefits to it. So it's like, do that. Okay, then we look at our meat. How, or if you're eating meat or not, How is it being raised? Would you want to go visit that farm? Because if you would not feel good around that, then energetically that has an impact, right? What hormones are going into it? We look at those things. And the reality is, if you can't...   afford to make those choices wonderful. That happens. What do we do to feel the best about the options that we have in front of us? Fundamentally, I always say balance blood sugar and a nervous system that is stable and you're not having anxiety every time you put food in your mouth because you don't know what's in it. That is going to take us almost just as far as micromanaging every piece and every ingredient. Whole foods more often   eaten away that fills you up, that makes you feel good. And everything else from there is customizable. But I think I hear so many patients, they get so caught up in fresh, organic, grass fed, grass finished, researching the farm, and then they end up in McDonald's.   Michelle (32:57) Yeah, that's not good. Yeah, yeah. Yeah.   Sarah Wilson (32:59) because they're so overwhelmed, right? They're like, I'm just hungry. And so I always say like a happy balance is always gonna be the goal.   Michelle (33:08) Yeah, no doubt, for sure.   Sarah Wilson (33:10) And your microbiome loves colors and there's not many of those at McDonald's, so. Exactly.   Michelle (33:14) Yeah, variety for sure. Yes, totally. And then you were talking about like symptoms even without a diagnosis,   Sarah Wilson (33:24) So the blood work is one piece, right? So even without a diagnosis, you can do complete blood count. You can do something called a C -reactive protein, which is a marker of gut inflammation, liver inflammation. You can do an arethrocytes sedimentation rate. These are blood markers. But I also say, if you are struggling with joint aches and pains, if you feel like you're just getting older, if you are dealing with brain fog, if you...   Michelle (33:26) Mm   Mm   Sarah Wilson (33:53) have pain with your periods that we have normalized so much as a society. If you have period poops, if you have PMS that is affecting your quality of life, like we have so many of these symptoms that we've been told, I'm just getting older, I have aches and pains, I'm just bloated and gassy, it's not a big deal, I just have brain fog, I'm losing my memory, right? I can't remember where I put my keys.   I'm dealing with like menstrual challenge. That is all inflammation based, all of it. And as someone I think who lives in this world all the time, it's so easy to forget what it feels like to feel crappy until you get hit. And I have two small children. I have a two and a five year old. And so we're sick all the time, right? Like it's just the reality, daycare, school, people get sick. And   It's so easy to just again, lose track of what good actually feels like. And it doesn't include those things, right? You should wake up in the morning feeling rested, unless you have a child who has nightmares about monkeys, which happened to me. Right? But you should be able to sustain that energy throughout the day without eating food. You shouldn't have to compromise your activity and your work schedule based on pain.   Michelle (35:05) Right.   Sarah Wilson (35:17) and energy levels and your menstrual cycle or your digestion. And so many people are living in that state where they are.   Michelle (35:22) Yeah.   And so when you do have people that come in with inflammation, what are some of the ways that you address that   Sarah Wilson (35:33) absolutely. So my belief structures, there's only five to seven causes of disease, right? So we go through blood sugar dysregulation and insulin resistance, the gut microbiome, immune dysregulation, we've got liver issues, we have nutrient deficiencies, the nervous system, and then we have the components of cellular energy production, or what we call our mitochondria, right? So these are the components of health. And at the end of every piece of that,   you're going to have a stress response and an inflammatory response, which is what most people are dealing with in today's day and age is they're struggling between that balance of stress response and inflammation. So my job is always going through those components and saying, which are the top two or three for you, right? If we're talking about microbiome issues and the immune system as two key pieces.   And then we say, okay, let's compliment that with the nervous system because we just talked about that. If those are someone's top three pieces, then first and foremost, we have to go through and say, what are the biggest obstacles? What are your gut symptoms? Does that suggest that you might have an overgrowth of methane species? Right? Does that, that tends to be constipation, lots of gas that doesn't smell great. Is it suggesting that you have hydrogen overgrowth? Right?   that's lots of gas that doesn't necessarily have a smell. We can go through, pick those apart. Do you have a history of parasites? Right, do you camp a lot? Those pieces, we're using antimicrobials in those situations to try to create some stability. We're trying to understand how that's gonna relate to blood sugar, et cetera. When it comes to looking at the immune system, there are key nutrients like vitamin D. If you don't have vitamin D,   at the right level, which most of us do not, that's a master controller of your immune system. So we need to have that in place. We also need to look at your viral history. So we know right now, research is showing that you can retain components of viruses for years. We've seen that people have reactivation of chronic viruses and those are directly affecting the lining of their uterus, they're directly affecting their ovaries.   Michelle (37:44) Mm   Sarah Wilson (37:55) and their whole pelvic health. So in that situation, we're saying, okay, what antivirals need to come into the mix? And what do we need, again, to look at from a holistic perspective? I know you've had so many people on here that talk about NAC and N -acetylcysteine and alpha -lipoic acid and CoQ10. And oftentimes what they're doing is just helping with those inflammatory cycles.   Michelle (38:22) Mm   Sarah Wilson (38:22) right, they're helping to restore balance to that inflammatory pathway. And then the nervous system comes in because that affects blood flow that affects your immune system's ability to do its job. And we say what works for you? Is that nerve nerves, right? That's where our valerian our passionflower, our zycephos come into the mix and are so beautiful. Is that going to be something where it's we're looking at meditation and walking?   and all of those pieces. that's really the approach I take, is I say, in those five to seven different causes that someone could have, what are the most important pieces for them? And then we dig into it at depth to say what components, whether that's using blood work, whether that's using functional testing, honestly, at this point, having seen as many patients as I've seen, sometimes it's insane. You're like, okay, I think we need anti -microbials.   some valerian and passion flower, and we need to correct the nutrient deficiencies that are present with respect to vitamin D and some of those antioxidants. We need to get enough protein, more colors, Bob's your uncle. But it's, I always say, health is so simple, and we have so much time and energy dedicated to making it really hard. And...   Michelle (39:31) Right.   Sarah Wilson (39:42) the more sophisticated I get, the more sophisticated the research gets, the more I go down rabbit holes, the more I come back to the same things. And I think there's so much peace in that too, to know that, yes, I have a lot of patients with very chronic health issues, with very significant imbalances, but the body wants to come back to those places and we just need to figure out which levers to pull to get it back to health.   Michelle (39:49) Right.   I love how you put that. It's true. It's just like, are the levers to pull, to try to help it do its job. what it wants to do really, it's like its purpose.   Sarah Wilson (40:24) Exactly. it's so, like sometimes you're pulling the same levers in rotation, right? You're like, okay, blood sugar, stress response, liver. And then you're like, inflammation, gut microbiome, stress response, blood sugar, liver. It's, you sometimes have to cycle back to those pieces. There's like the layers of the healing onion. So as we always say, but it's, there's so much simplicity that can be had within all of it. And I really want people to feel that because I think,   Michelle (40:28) Mm -hmm.   Right. Yeah.   Sarah Wilson (40:50) There's a lot of energy now being dedicated to feeling like health is gate kept and it's not, right? This is why we come on these podcasts. This is why we do these things. If anyone today says, I feel empowered, I can take action here. I'm gonna add more vegetables. I'm gonna add more colors. I'm gonna go for a walk after my meals, ideally in nature. I'm gonna look at what brings me joy.   Michelle (40:57) Yeah.   Sarah Wilson (41:17) and include more of that. I'm gonna work on my boundaries, I'm gonna correct my nutrient deficiencies, and I'm gonna look at my microbiome. You will get so far, so far in your health. And that to me is just, it's so beautiful.   Michelle (41:26) Yeah.   yeah, for sure. mean, it's really empowerment. So, well, this is great. You shared so much amazing information. I could definitely keep talking to you because there's just so much that we can keep unpacking. But if people are interested in working with you, want to find out more about you, how can they find you?   Sarah Wilson (41:53) Yeah, absolutely. Well, thank you. know I was, these are always such loaded conversations because we start and it's like, do we go here? Do we go here? So exactly.   Michelle (42:00) I know. There's just a, a, branches out and it has, it starts to take a life of its own. And then I'm like, okay, well, we still can't keep going, going, going. at one point.   Sarah Wilson (42:11) I know totally. Yeah, so I, as I said, for anyone listening in Canada, I own Advanced Women's Health. So we have clinics across Ontario and BC and we're expanding. I have a whole team of practitioners that do clinical rounds every day and I work with all the time. For those of you in the US, I do have courses where I train naturopathic doctors. So if you like this approach and you want people who are in the US and beyond.   then you can always reach out to my team as well. Their email is just info at advancedwomenshealth .ca and they've got that list of practitioners. So in either situation, we can help you out. I also poke around on Instagram. I do not post on there as much as I should, but it's always a goal. And yeah, I'm just so happy to connect with the audience.   Michelle (42:52) Amazing. Well, Dr. Wilson, this was very informative and I love the fact that you do so much research and this is based on like real data and real information and you really understand it. Your mind tends to work that way, which is awesome because you have to find a career where your mind is really able to absorb that information and then apply it. And it sounds like you found a perfect.   career for what you do and you're passionate about it as well.   Sarah Wilson (43:20) Thank you. Yeah, no, I'm so fortunate. I love what I do. And like, I'm so fortunate that I get to build a team of people that begrudgingly love my brain. They're always on calls because we meet every day. So our team of practitioners meets every day and they're always asking questions and I'll spin out on something and I'll be like, welcome to the Ted Talk. Sorry, that just happened.   Michelle (43:31) No, it's very interesting.   Amazing.   That's great. Well, that's how you know you love it. That's how you know it.   Sarah Wilson (43:44) Yes. Yeah, exactly. Exactly. Well, thank you so much for having me. It's been such a joy. yeah, I just I love sharing this information. I'm happy to come back and share more anytime.   Michelle (43:55) Yes. So thank you so much for coming on.    

From the Viruses of Microbes meeting in Cairns, Australia, TWiV speaks with Krystyna and Rob about their research on using bacteriophages to treat bacterial infections. Hosts: Vincent Racaniello and Jolene Ramsey Guests: Krystyna Dabrowska and Rob Lavigne Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server Viruses of Microbes 2024 Immune responses to phages (Front Immunol) Engineering bacteriolytic enzymes (Front Immunol) 100 cases of phage therapy (Nat Micro) Synthetic biology potential of bacteriophages (Nat Micro) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content in this podcast should not be construed as medical advice.

Free book is here at https://www.memorizingpharm.com/books In this episode we return to turning the open educational nursing resource for nursing pharmacology into audio, we'll start with the 1st edition antimicrobials then move on to the new second edition with the next topic.  Summary - 3.8 Monobactams Overview and Quiz  Chapter 3.8 of the Nursing Pharmacology guide covers monobactams, a narrow-spectrum antibiotic class primarily effective against gram-negative bacteria like Pseudomonas aeruginosa. Monobactams disrupt bacterial cell wall synthesis and are administered intravenously, intramuscularly, or via inhalation. Nurses should monitor for GI symptoms, skin sensitivities, and coagulation abnormalities. Patient education emphasizes watching for signs of superinfection or allergic reactions. Multiple Choice Questions Monobactams work primarily by: a) Inhibiting protein synthesis b) Disrupting cell wall synthesis c) Blocking DNA replication d) Preventing RNA transcription Monobactams are most effective against: a) Gram-positive bacteria b) Viruses c) Gram-negative bacteria d) Fungi How are monobactams commonly administered? a) Orally b) Topically c) Intravenously, intramuscularly, or via inhalation d) Subcutaneously What should patients monitor for when taking monobactams? a) Increased appetite b) Hair growth c) Signs of superinfection d) Weight gain Patients with allergies to which medication classes should be cautious with monobactams? a) Tetracyclines b) Penicillins, cephalosporins, or carbapenems c) Macrolides d) Antivirals Answer Key b) Disrupting cell wall synthesis c) Gram-negative bacteria c) Intravenously, intramuscularly, or via inhalation c) Signs of superinfection b) Penicillins, cephalosporins, or carbapenems  

On the verge of a post-antibiotic reality, there is an urgent clinical need for new antibiotics. Luckily, new candidates are in the pipeline and older agents are getting a second breath of life through combination therapy.  In this episode of Communicable, host Erin McCreary invites Dr. Markus Zeitlinger of the University of Vienna (Austria) and scientific expert for the European Medicines Agency (EMA) and Dr. Michael Dudley, president and CEO of Qpex Biopharma, to discuss antimicrobials in the clinical development pipeline.  Together they unpack how the WHO curate the priority list of pathogens and how companies adapt such lists into their antimicrobial development business plans. They also discuss the unique challenges and complexities of developing antibiotics, from return on investments and defining the ‘novelty' of an agent to the conundrum of balancing post-market approval and antimicrobial stewardship. Beta-lactamase inhibitors and oral carbapenems in the pipeline targeting ‘the big three' (Enterobacterales, Pseudomonas and Acinetobacter) are the primary focus. This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Benjamin Berinson of the Medical Centre Hamburg-Eppendorf (UKE), Germany. For more information on the WHO Priority Pathogens List and its 2024 update, check out our previous episode, Communicable E3 (see Literature).  Literature  Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? 17 June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first  WHO Bacterial Priority Pathogens List, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: World Health Organization; 17 May 2024. https://www.who.int/publications/i/item/9789240093461  C. Le Terrier et al, NDM-9 resistance to taniborbactam. Lancet Infect Dis 23, 401-402 (2023). doi 10.1016/S1473-3099(23)00069-5      P. B. Eckburg et al, Oral Tebipenem Pivoxil Hydrobromide in Complicated Urinary Tract Infection. N Engl J Med 386, 1327-1338 (2022). doi: 10.1056/NEJMoa2105462  A Study of Oral Tebipenem Pivoxil Hydrobromide (TBP-PI-HBr) Compared to Intravenous Imipenem-cilastatin in Participants With Complicated Urinary Tract Infection (cUTI) or Acute Pyelonephritis (AP) (PIVOT-PO). https://clinicaltrials.gov/study/NCT06059846 Meiji Seika Pharma Initiated the Global Phase III Clinical Trials of OP0595, a Novel beta-Lactamase Inhibitor for Combatting Antimicrobial Resistance (AMR). Tokyo: Meiji Seika Pharma Ltd; 26 April 2023. https://www.meiji.com/global/news/2023/pdf/230426_01.pdf

On episode #63 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 8/29/24 – 9/13/24. Host: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Postacute Sequelae of COVID (PASC or Long COVID): An Evidenced-Based Approach (OFID) A New Orthonairovirus Associated with Human Febrile Illness (NEJM) Farmed fur animals harbour viruses with zoonotic spillover potential(Nature) A Cross-Sectional Evaluation of the Virtual Outpatient Management of People With Mpox (OFID) A randomized, placebo-controlled, dose-escalation phase I/II multicenter trial of low-dose cidofovir for BK polyomavirus nephropathy (Transplant Infectious Disease) A Decade of Chronic Norovirus Infection Surveillance at the NIH Clinical Research Center: Clinical Characteristics, Molecular Epidemiology, and Replication (JID) Bacterial FDA clears newLyme disease test (CIDRAP) Lyme ImmunoBlot Receives FDA Clearance(Accesswire) The Utilization Of Echocardiography In Children With Staphylococcus aureus Bacteremia (Journal of Pediatric Infectious Diseases Society) Duration of antibiotic therapy for multidrug resistant Pseudomonas aeruginosa pneumonia: is shorter truly better?(BMC Infectious Diseases) Short Versus Long Antibiotic Duration in Streptococcus pneumoniae Bacteremia (OFID) FDA Marketing Authorization Enables Increased Access to First Step of Syphilis Diagnosis FDA) Clinical impact of pleural fluid Streptococcus pneumoniae PCR testing in children with complicated pneumonia (CID) Duration of antibiotic therapy for multidrug resistant Pseudomonas aeruginosa pneumonia: is shorter truly better? (BMC Infectious Diseases) Short Versus Long Antibiotic Duration in Streptococcus pneumoniae Bacteremia (OFID) Fungal The Last of US Season 2 (YouTube) Incidence and risk factors for invasive fungal infections in patients initiating TNF-alpha inhibitors for inflammatory bowel disease and rheumatoid arthritis (CID) Parasitic Intestinal helminth infection impairs vaccine-induced T cell responses and protection against SARS-CoV-2 in mice(Science Translational Medicine) Miscellaneous Successful Treatment of Refractory Cutaneous Protothecosis With MAT2203, an Oral Lipid Nanocrystal Formulation of Amphotericin B (OFID) The Impact of Infectious Diseases Scholarly Mentorship on Subsequent Infectious Disease Fellowship Application (CID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

Heteroresistance is a phenomenon that has been well characterized for many years. However, we are only now starting to understand its mechanistic basis. Indeed, the manner how bacteria respond to antibiotics is complex and phenomena such as persistance, tolerance may be overlapping with heteroresistance. Furthermore, heteroresistance seems to be common in real clinical scenarios and understanding its basis is likely to open new avenues on how we deploy antibacterials in clinical practice., Today, we have experts in the field to discuss this important topic. Watch this episode at https://youtu.be/qcIcyn1bIHU. Topics discussed: The differences between heteroresistance, persistence and tolerance The mechanistic basis both in Gram-positive and Gram-negative bacteria The clinical implication and diagnosis of heteroresistance Guests: David Weiss, Ph.D. Professor of Medicine and Director Center for Antimicrobial Resistance, Emory University School Of Medicine, Atlanta. GA. William Miller, MD. Assistant Professor of Medicine, Houston Methodist, Houston, TX and Weill Cornell Medical College, New York, NY. Links: Cefiderocol heteroresistance associated with mutations in TonB-dependent receptor genes in Pseudomonas aeruginosa of clinical origin This episode is brought to you by the Antimicrobial Agents and Chemotherapy journal.  Visit asm.org/aac to browse issues and/or submit a manuscript. If you plan to publish in AAC, ASM Members get up to 50% off publishing fees. Visit asm.org/joinasm to sign up. Follow Cesar on twitter at https://twitter.com/SuperBugDoc for AAC updates.  Subscribe to the podcast at https://asm.org/eic.

“It is a team effort to protect public health from Legionella.” - Alberto Comazzi, Ph.D. We are excited to welcome back Alberto Comazzi, Ph.D. of Sanipur US, for his third appearance on the Scaling UP! H2O Podcast. As an expert in waterborne pathogens, Alberto shares his invaluable insights and experiences about Legionella to help our audience stay informed and proactive in managing water systems. In this episode, we cover a wide range of topics from handling positive Legionella tests to the effectiveness of monochloramine in disinfection. Let's dive into the key points of our discussion. How do you handle a call from a client panicking about their first positive Legionella test? Alberto advises us to stay calm and follow the pre-established plan outlined in the Water Management Plan (WMP). First, review the WMP to understand the specific steps to take for this scenario. Consider the positivity rates and the location where Legionella was found. By following the agreed-upon plan, you can address the client's concerns effectively and ensure proper action is taken.  Why have we seen Legionella increase by nearly ten times over the past few years? “5-6 years ago there wasn't much information about Legionella, and today so many people are interested in this field which protects public health.” - Alberto Comazzi, PhD Dr. Comazzi highlights two key factors behind the significant rise in Legionella cases: 1. Enhanced Water Testing and Awareness: The past few years have seen a substantial increase in both awareness and testing for Legionella. Healthcare professionals are now more informed about the risks of Legionella and are conducting more tests. Since 2017, the requirement for Water Management Plans (WMPs) in healthcare facilities has led to more comprehensive water testing, contributing to the rise in detected cases. 2. Increased Water Age in Buildings: Efforts to conserve water, which have important environmental benefits such as saving energy and reducing costs, have inadvertently led to higher water age in building systems. When water remains in systems for longer periods, it can lead to reduced disinfectant levels and higher water temperatures—conditions that promote Legionella growth. While water conservation is crucial, balancing it with effective Legionella control measures is essential for maintaining public health. By understanding these factors, we can better address and mitigate Legionella risks, ensuring a safer environment for everyone. What advice do you have for those putting together a WMP but who doesn't have the ASSE 1280 Certification? Get Certified or Seek Expert Help: Creating a comprehensive Water Management Plan (WMP) can be complex. While obtaining ASSE 1280 certification is highly recommended, you can also consider hiring a consultant to help you draft your plan. However, it's crucial to ensure that you execute and document the plan effectively. Proper training for facility operators on temperature control, flushing procedures, disinfectant management, and documentation is essential. “A Water Management Plan that's just sitting on the shelf isn't doing anyone any good. If no one implements the plan, it is useless.” Dr. Alberto Comazzi emphasizes, “Proactive measures are better and more cost-effective than reactive ones.” With upcoming due diligence plans addressing various waterborne pathogens, being prepared is key. Who has responsibility when it comes to municipal water? Alberto reminds us that there is a division between the municipality and the building. Municipal Water Responsibility: Municipal water suppliers are responsible for providing water that meets regulatory standards up to the distribution system. They conduct primary disinfection to inactivate most microorganisms and secondary disinfection to maintain a residual disinfectant. However, there are no enforceable limits for Legionella in the municipal water supply, and testing for Legionella is not required. Building-Level Responsibility: Once water leaves the municipal system and enters a building, the responsibility for water safety, including Legionella control, falls to the building owner or manager. Building environments, with their complex plumbing systems, cooling towers, and hot water systems, can foster Legionella growth. Therefore, effective management and control measures at the building level are crucial for ensuring water safety. Monochloramine vs. Chlorine: Which is better Disinfection and Legionella Control in Building Water Systems? Alberto highlights the advantages of monochloramine over chlorine: Case Study Results: A case study in San Francisco showed that switching from chlorine to monochloramine in the municipal water supply significantly reduced Legionella positivity rates in buildings—from 60% to 3-4%. This demonstrates the effectiveness of monochloramine in providing better overall disinfection due to its stability and ability to maintain higher disinfectant levels in building plumbing systems. Comparison with Chlorine: Monochloramine, unlike chlorine, is less reactive with organic materials in water and thus produces fewer regulated disinfection byproducts. It is a more stable disinfectant, which makes it less likely to form harmful byproducts while still providing effective disinfection. Effectiveness in Building Systems: In building water systems, especially those with low water usage or higher temperatures, monochloramine's stability is advantageous. It provides a more consistent and longer-lasting disinfectant presence throughout the system, reaching all areas effectively, which is crucial for preventing Legionella growth. What long-term effects on sustainability and equipment should we consider when balancing water conservation with the use of additional disinfectants in buildings? Alberto outlines key considerations: Corrosion Impact: When installing additional disinfectants, consider their potential to corrode plumbing systems. High levels of corrosive disinfectants can damage plumbing, so it's crucial to balance disinfection effectiveness with the preservation of the building's infrastructure. Water Quality Effects: Assess whether the chosen disinfectant might increase other harmful molecules in the water. Evaluate disinfection efficacy not only in the lab but also in real-world building settings to ensure it does not negatively impact overall water quality. Review Published Data: Refer to peer-reviewed literature and research from credible sources like the EPA to verify the long-term effects of disinfectants on water systems. Reliable data helps ensure that the disinfectant does not introduce unintended consequences and maintains water quality over time. How did monochloramine perform in controlling Pseudomonas compared to traditional methods? In a case study, monochloramine was implemented in facilities with Pseudomonas issues and proved effective in reducing colonization. "Unlike short-term solutions like flushing and hyperchlorination, monochloramine's stability allowed it to reach all parts of the distribution system, providing long-term control" shares Alberto. Timestamps 01:00 - Trace Blackmore invites you to celebrate Legionella Awareness Month  05:50 - Upcoming Events for Water Treatment Professionals 11:00 - Interview with Alberto Comazzi, Ph.D. 01:01:30 - Drop by Drop with James McDonald Connect with Alberto Comazzi, Ph.D. Phone: 267-326-2353 Email: a.comazzi@sanipur.com Website: www.sanipur.com    Linkedin: /in/alberto-comazzi-phd-132637128/  company/sanipur-us-llc Technical Paper: Emerging Waterbone Pathogens in Buildings' Premise Plumbing System Links Mentioned All links mentioned on this episode can be found on our Legionella Resources page HERE The Rising Tide Mastermind Scaling UP! H2O Academy video courses Drop By Drop with James In today's episode, I have a challenge for you.  Today's challenge is…test boiler sulfite both immediately after sampling and again an hour later on the same, open sample.  Is there a difference?  Why is there a difference?  What would be the impact of waiting until later to run the sulfite test versus running it immediately?  How might your recommendations be different?  Could the way you run your test impact your results, such as how much you agitate the sample? 2024 Events for Water Professionals Check out our Scaling UP! H2O Events Calendar where we've listed every event Water Treaters should be aware of by clicking HERE.

We've recorded a series of podcasts on the microbiome and its wide ranging impacts. But boy is this a field that moves rapidly. As soon as you think you've covered much of the territory, along comes some new and exciting findings, and this is the case today. We're going to describe research done by our guest, Dr. Ibrahim Javed. He has done innovative work on links between the gut microbiome and the brain, particularly focused on Alzheimer's disease. Dr. Javed is an Enterprise Fellow and National Health and Medicine Research Council Emerging Leadership Fellow in Clinical and Health Sciences at the University of South Australia. Interview Transcript So let's begin, if you wouldn't mind, with an explanation from you about what the gut brain axis is and tell us how it's important. Yep. Now we see a lot of, a lot of researchers around the globe building on investigations around the gut brain axis. But if we, if we investigate what this gut brain axis actually is, It's kind of like a bi-directional communication between two organs in our body, the gut and the brain. And when we particularly talk about gut, we have our stomach and our different portions of the intestine. What we're actually interested in is the microbiome and all those small little things living inside the gut. There are around 100 trillion microbes in the gut, which is three times more than the number of cells in our body. So, we are kind of like more microbes than, than human cells. And they communicate with different organs in our body and how they communicate with the brain that we can describe it as a, as a gut brain axis. And then this whole gut brain axis thing was somehow kind of invisible to us. We were just looking at it as a fecal material or waste coming out of our body. But now we see a lot of importance to these gut microbes. They help us in a lot of daily things that we do. They shape our behavior, our response to stress, our immune system, and then how we respond to different medicines, and how we do our daily tasks. So, they have a lot of roles in that. They help us digest food, that's their main obvious function. But now we are more. getting more and more information about them, that how they are integrated with a lot of different things in our body. So, kind of like they are partners in our life. That's a very, very nice explanation. Can you tell us about the importance of microbial diversity? Yep. So microbial diversity, we can, we can refer to, to as a composition of all those bacteria, viruses, and fungi to some extent that, that live in, in our body. Digestive track and, and in a lot of other animals as well. And this diversity is very crucial in maintaining the gut health and on overall well-being of, of humans. And, and this microbiome whole thing is like, it is obviously associated with a lot of health benefits and, and how we develop disease, but it's also right from the beginning of life they help us in developing our brains. They help us mature the brain system and the immune system. Obviously, they help us in digesting food. So, generally, we can actually divide them in two portions. One, we can call them a good gut bacterium. They help us with all these things. And then they are bad gut bacteria, which are kind of like kept within a within a bay. They are kept under control by this good gut bacteria with the help of the rest of our body. And in somehow in some conditions with the age or with the dietary habits or environmental factor or lifestyle, if they overcome and, and they take over the control in the gut, that's where the thing starts going haywire. When I was growing up, microbes were a bad thing. You didn't want to have microbes. And now, now we hear that there are good microbes and now you're talking about the balance. There are still bad ones, but good ones. And the balance of those two was a really important thing. Let's talk about how bad bacteria find their way to the brain. How do they get access? So, as we discussed, they are kept within the bay or kept under control by good bacteria and also by other different immune systems in the body. We have different checkpoints, like we have different barriers or three different compartments, the gut and the blood and the brain. And we have barriers that separate out these compartments and these barriers are very tightly controlled, very good health cells tightly integrated with each other and they police that whole things what need to go across and what does not need to go across what we need to stop it within that compartment. If we have adverse environmental factors, or poor dietary habits and these bad gut bacteria overcome, they produce a lot of different molecules to communicate with each other. And they produce a lot of different molecules to take over the good bacteria. And these molecules, they can get across those barriers, and specifically if they can get into the brain (that's what we are researching), they can do a lot of different bad things in the brain. They can do that by hijacking this gut brain axis. And this compartmental thing is one pathway that they can get from gut to the blood and then from the blood to the brain. But there is also a direct highway that connects gut to the brain and that's our enteric nervous system. These are specific nerves or neurons, for example, vagus nerve, they're quite famous. It's a direct link between the gut and brain. This nerve system helps us in a lot of different daily tasks without us even knowing about it, like digestion and heart rate and respiration, and emptying the stomach. And these are kind of like a pathway for bidirectional communication. So, a lot of molecules go up and down across these highways and the bad gut bacteria can actually hijack it and they can put their stuff into this highway and they can send it across the brain. It's a very, very nice explanation you have of a very complicated process, and I find it absolutely fascinating. So, you've spoken about how bad bacteria can be opportunistic pathogens and can trigger problems or enhance the progression of existing problems. How does all that work? So, we are investigating bad gut bacteria in connection with dementia and Alzheimer disease. We are specifically working on Pseudomonas aeruginosa and E. coli and they are quite common, like a lot of school kids. They know about these bacteria. They are quite commonly studied in high school microbiology. So, these bacteria produce some molecules which help to make biofilms around them. They kind of build a castle around them to protect their colonies and for their own survival and they keep surviving then until they get an opportunity to expand their castles and build more biofilms. These molecules are quite similar in terms of their structure and in terms of how they communicate. With some proteins which are not related to bacteria anyhow, they are produced in the brain to do some normal stuff in the brain, but they also aggregate in Alzheimer disease using the same mechanism as the nature that these bacteria use for these proteins to make their biofilms. Based on this common similarity, if they can somehow see each other, or if those gut bacteria can send those proteins or aggregate of those proteins across the brain through using those highways. They can induce the aggregation of those normal, naive, working, innocent proteins, which we have in our brain that have nothing to do with the bacteria. But if they can be accessed by those bacterial proteins, they go haywire and, and they trigger the onset of the disease, or if there is already going on, that they can actually accelerate that whole process. And this is a concept, actually, we have seen that concept before in prion disease, whereby eating infected food that have those prion particles, they can actually go from gut to the brain, and they can induce the normal prion protein in the brain to start making aggregates in a similar way. Are there interventions that can stop the pathogenic bacteria from in the gut that might in turn affect the brain? We should focus more on preventive measures. We can focus on maintaining a good diversity within the gut of having or supporting those good bacteria in that fight and keeping them healthy and alive as we age. Because as we age over the period of life, we keep losing those good bacteria. If we can have all those good things of exercise, balanced sleep, and more importantly, good food and a balanced variety of food. Then we have a lot of different varieties to support that variety of gut bacteria in the gut. So that's, I think, the most important preventive measure to keep that balance intact. But of course, in the future as a therapeutic intervention, we are moving towards developing microbiome therapies where we can modulate those compositions. If that composition is not in a very good situation, we can actually modulate that by using probiotics and prebiotic dietary factors or some microbial compositions like yogurt and a lot of other foods. We can modulate that to inoculate those bacteria which are missing in the gut and, and try to achieve that balance and, and that balance will accelerate the effectiveness of the medicine which we are taking for any other disease. The advice we've heard from some of our other guests is to eat a diet rich in fruits and vegetables. You know, consume things, you mentioned yogurt, kefir, kombucha, sauerkraut, and things like that. Sound like they're very good for enhancing the health of the microbiome. Is there anything else beyond that that might be relevant for the brain in particular? For brain health, there are some antioxidant foods. For example, we have Curcumin, and some senolytic compounds. We cannot call them drugs because they are kind of like a food supplements. They are available in any pharmacy and super stores by a lot of different names. Mostly these are polyphenolic compounds. They are usually available in green tea and in green tea extracts. They are quite well known for their healthy and antioxidant and anti-inflammatory effects. Research around the globe has shown that there are good effects directly on the brain by these polyphenolic compounds. So, these are green tea extracts, quercetin and, and some other galectin compounds. BIO Dr Ibrahim Javed is currently an Enterprise Fellow (Senior Lecturer) and NHMRC Emerging Leadership Fellow at the Clinical and Health Sciences, University of South Australia. He is also an adjunct Senior Research Fellow at the Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland. He completed his doctoral studies at the Monash Institute of Pharmaceutical Sciences in 2020 and postdoctoral research at AIBN, The University of Queensland. He joined the University of South Australia in 2023 where he is now directing the laboratory of Gut-Brain Axis, Aging and Therapeutics. Research in Javed's lab focuses on the gut-brain axis and its implications for aging and Dementia. His research team is working to unfold the specific role of bad/pathogenic gut bacteria in the aging paradigms and Dementia associated with Alzheimer's and Parkinson's diseases. His team has discovered and published the molecular details of how bad bacteria in the gut can trigger a younger onset (aged under 65) and accelerate Dementia and how the brain can develop Dementia when fighting with microbial biofilms in the gut – the infectious etiology of Dementia. With this research trajectory, his vision is to develop a multifaceted therapeutic intervention for aging-associated diseases and Dementia. 

TWiM explores evolution and host adaptation of Pseudomonas infections of plants, and the impact of COVID-19 on ESBL-producing E. coli on urinary tract and blood infections. Hosts: Vincent Racaniello and Michael Schmidt. Become a patron of TWiM. Links for this episode Evolution and host adaptation of Pseudomonas (Science) Type III secretion system, infection by injection (Nat Comm) Demographic inference with skyline plots (Peer J) Skyline plots (Taming the Beast) Panaroo, a bacterial genome analysis pipeline (Wellcome Sanger Inst) Impact of COVID-19 on ESBL-producing E. coli infections (Antimicro Resist Inf Control) Take the TWiM Listener survey! Music used on TWiM is composed and performed by Ronald Jenkees and used with permission. Send your microbiology questions and comments (email or recorded audio) to twim@microbe.tv

The ‘I' (intermediate susceptibility) in a EUCAST-guided antibiogram never meant impending resistance to your antibiotic. It was never meant to make you find the one ‘S' (invariably a carbapenem) and use it instead—even if many clinicians did. In this episode of Communicable, hosts Marc Bonten and Angela Huttner welcome Profs. Christian Giske (outgoing chair) and Sören Gatermann (newly elected chair) of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) to discuss its recent updates, including the new ‘susceptible dose dependent' (SDD) label, and to shed light on common misconceptions around the way it sets breakpoints. Breakpoints for Pseudomonas aeruginosa are discussed, as are intravenous fosfomycin's ‘disappearance' from the breakpoints table and EUCAST's new guidance on it. Episode peer-reviewed by Dr. Suzanne van Asten of Radboud University Medical Center.Literature:The European Committee on Antimicrobial Susceptibility Testing (EUCAST): https://www.eucast.org/EUCAST guidance on use of fosfomycin i.v. breakpoints:https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Guidance_documents/Use_of_fosfomycin_iv_breakpoints_General_advice_20240528.pdfIn vitro synergy between fosfomycin and ceftazidime/avibactam: Kroemer, Martens, Decousser et al. Evaluation of in vitro pharmacodynamic drug interactions of ceftazidime/avibactam and fosfomycin in Escherichia coli. J Antimicrob Chemother. 2023 Oct 3;78(10):2524-2534. doi: 10.1093/jac/dkad264

Episode 173: Acute OsteomyelitisFuture Dr. Tran explains the pathophysiology of osteomyelitis and describes the presentation, diagnosis and management of acute osteomyelitis. Dr. Arreaza provides information about    Written by Di Tran, MSIII, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is osteomyelitis?Osteomyelitis, in simple terms, is an infectious disease that affects both bone and bone marrow and is either acute or chronic.  According to archaeological findings of animal fossils with a bone infection, osteomyelitis was more than likely to be known as a “disease for old individuals”.Our ancestors over the years have used various vocabulary terms to describe this disease until a French surgeon, Dr. Nelaton, came up with the term “Osteomyelitis” in 1844. This is the beauty of medical terms, Latin sounds complicated for some people, but if you break up the term, it makes sense: Osteo = bone, myelo = marrow, itis = inflammation. So, inflammation of the bone marrow.Traditionally, osteomyelitis develops from 3 different sources:First category is the “hematOgenous” spread of the infection within the bloodstream, as in bacteremia. It is more frequent in children and long bones are usually affected. [Arreaza: it means that the infection started somewhere else but it got “planted” in the bones]Second route is “direct inoculation” of bacteria from the contiguous site of infection “without vascular insufficiency”, or trauma, which may occur secondary to fractures or surgery in adults.  In elderly patients, the infection may be related to decubitus ulcers and joint replacements.And the third route is the “contiguous” infection “with vascular insufficiency”, most seen in a patient with a diabetic foot infection.Patients with vascular insufficiency often have compromised blood supply to the lower extremities, and poor circulation impairs healing. In these situations, infection often occurs in small bones of the feet with minimal to no pain due to neuropathy.They can have ulcers, as well as paronychia, cellulitis, or puncture wounds.Thus, the importance of treating onychomycosis in diabetes because the fungus does not cause a lot of problems by itself, but it can cause breaks in the nails that can be a port of entry for bacteria to cause severe infections. Neuropathy is an important risk factor because of the loss of protective sensation. Frequently, patients may step on a foreign object and not feel it until there is swelling, purulent discharge, and redness, and they come to you because it “does not look good.”Acute osteomyelitis often takes place within 2 weeks of onset of the disease, and the main histopathological findings are microorganisms, congested blood vessels, and polymorphonuclear leukocytes, or neutrophilic infiltrates.What are the bugs that cause osteomyelitis?Pathogens in osteomyelitis are heavily depended on the patient's age.  Staph. aureus is the most common culprit of acute hematogenous osteomyelitis in children and adults.  Then comes Group A Strep., Strep. pneumoniae, Pseudomonas, Kingella, and methicillin-resistant Staph. aureus.  In newborns, we have Group B Streptococcal. Less common pathogens are associated with certain clinical presentations, including Aspergillus, Mycobacterium tuberculosis, and Candida in the immunocompromised.Salmonella species can be found in patients with sickle cell disease, Bartonella species in patients with HIV infection, and Pasteurella or Eikenella species from human or animal bites.It is important to gather a complete medical history of the patient, such as disorders that may put them at risk of osteomyelitis, such as diabetes, malnutrition, smoking, peripheral or coronary artery disease, immune deficiencies, IV drug use, prosthetic joints, cancer, and even sickle cell anemia. Those pieces of information can guide your assessment and plan.What is the presentation of osteomyelitis?Acute osteomyelitis may present symptoms over a few days from onset of infection but usually is within a 2-week window period.  Adults will develop local symptoms of erythema, swelling, warmth, and dull pain at the site of infection with or without systemic symptoms of fever or chills.Children will also be present with lethargy or irritability in addition to the symptoms already mentioned.It may be challenging to diagnose osteomyelitis at the early stages of infection, but you must have a high level of suspicion in patients with high risks. A thorough physical examination sometimes will show other significant findings of soft tissue infection, bony tenderness, joint effusion, decreased ROM, and even exposed bone. Diagnosis.As a rule of thumb, the gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathology findings and tissue culture. There is leukocytosis, but then WBC counts can be normal even in the setting of acute osteomyelitis.Inflammatory markers (CRP, ESR) are often elevated although both have very low specificity. Blood cultures should always be obtained whenever osteomyelitis is suspected.  A bone biopsy should also be performed for definitive diagnosis, and specimens should undergo both aerobic and anaerobic cultures.  In cases of osteomyelitis from diabetic foot infection, do the “probe to bone” test. What we do is we use a sterile steel probe to detect bone which is helpful for osteomyelitis confirmation.Something that we can't miss out on is radiographic imaging, which is quite important for the evaluation of osteomyelitis.  Several modalities are useful and can be used for the work-up plan; plain radiographs often are the very first step in the assessment due to their feasibility, low cost, and safety.  Others are bone scintigraphy, CT-scan, and MRI.  In fact, the MRI is widely used and provides better information for early detection of osteomyelitis than other imaging modalities.  It can detect necrotic bone, sinus tracts, and even abscesses. We look for soft tissue swelling, cortical bone loss, active bone resorption and remodeling, and periosteal reaction.  Oftentimes, plain radiography and MRI are used in combination. Treatment:Treatment of osteomyelitis actually is a teamwork effort among various medical professionals, including the primary care provider, the radiologist, the vascular, the pharmacist, the podiatrist, an infectious disease specialist, orthopedic surgeons, and the wound care team.Something to take into consideration, if the patient is hemodynamically stable it is highly recommended to delay empirical antibiotic treatment 48-72 hours until a bone biopsy is obtained.  The reason is that with percutaneous biopsy ideally done before the initiation of antibiotic treatment, “the microbiological yield will be higher”.We'll have a better idea of what particular bugs are causing the problem and guide the treatment appropriately. The choice of antibiotic therapy is strongly determined by susceptibilities results.  The antibiotic given will be narrowed down only for the targeted susceptible organisms.  In the absence of such information, or when a hospitalized patient presents with an increased risk for MRSA infection, empiric antibiotic coverage is then administered while awaiting culture results. It should be broad-spectrum antibiotics and include coverage for MRSA, broad gram-negative and anaerobic bacteria.  For example, vancomycin plus piperacillin-tazobactam, or with broad-spectrum cephalosporin plus clindamycin.  Treatment will typically be given for 4 to 6 weeks.The duration between 4-6 weeks is important for complete healing, but a small study with a small sample showed that an even shorter duration of 3 weeks may be effective, but more research is needed. In certain situations, surgery is necessary to preserve viable tissue and prevent recurrent infection, especially when there are deep abscesses, necrosis, or gangrene, amputation or debridement is deemed appropriate. If the infected bone is completely removed, patients may need a shorter course of antibiotics, even a few days only. Amputation can be very distressing, especially when we need to remove large pieces of infected bone, for example, a below-the-knee amputation. We need to be sensitive to the patient's feelings and make a shared decision about the best treatment for them.In patients with diabetes, additional care must be taken seriously, patient education about the need for compliance with treatment recommendations, with careful wound care, and good glycemic control are all beneficial for the healing and recovery process. Because this is a very common problem in the clinic and at the hospital, we must keep our eyes wide open and carefully assess patients with suspected osteomyelitis to detect it promptly and start appropriate treatment. Adequate and timely treatment is linked to fewer complications and better outcomes._________________________Conclusion: Now we conclude episode number 173, “Acute Osteomyelitis.” Future Dr. Tran explained the pathophysiology, diagnosis, and management of osteomyelitis. A bone biopsy is the ideal method of diagnosis. Delaying antibiotic treatment a few days until you get a biopsy is allowed if the patient is stable, but if the patient is unstable, antibiotics must be started promptly. Dr. Arreaza mentioned the implications of amputation and that we must discuss this treatment empathically with our patients. This week we thank Hector Arreaza and Di Tran. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Bury DC, Rogers TS, Dickman MM. Osteomyelitis: Diagnosis and Treatment. Am Fam Physician. 2021 Oct 1;104(4):395-402. PMID: 34652112.Cunha BA. Osteomyelitis in elderly patients. Clin Infect Dis. 2002 Aug 1;35(3):287-93. doi: 10.1086/341417. Epub 2002 Jul 11. PMID: 12115094.Fritz JM, McDonald JR. Osteomyelitis: approach to diagnosis and treatment. Phys Sportsmed. 2008 Dec;36(1):nihpa116823. doi: 10.3810/psm.2008.12.11. PMID: 19652694; PMCID: PMC2696389.Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011 Nov 1;84(9):1027-33. PMID: 22046943.Hofstee MI, Muthukrishnan G, Atkins GJ, Riool M, Thompson K, Morgenstern M, Stoddart MJ, Richards RG, Zaat SAJ, Moriarty TF. Current Concepts of Osteomyelitis: From Pathologic Mechanisms to Advanced Research Methods. Am J Pathol. 2020 Jun;190(6):1151-1163. doi: 10.1016/j.ajpath.2020.02.007. Epub 2020 Mar 16. PMID: 32194053.Momodu II, Savaliya V. Osteomyelitis. [Updated 2023 May 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532250/Royalty-free music used for this episode: Trap Chiller by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net 

First up this week, guest host Kevin McLean talks to freelance writer Andrew Zaleski about recent advancements in the world of synthetic blood. They discuss some of the failed attempts over the past century that led many to abandon the cause altogether, and a promising new option in the works called ErythroMer that is both shelf stable and can work on any blood type.   Next on the episode, producer Zakiya Whatley talks to Aaron Weimann from the University of Cambridge about the evolutionary history of the deadly bacterial pathogen Pseudomonas aeruginosa. They discuss how more than a century's worth of samples from all over the world contributed to new insights on the emergence and expansion of the pathogen known for its ability to develop antimicrobial resistance.   This week's episode was produced with help from Podigy.   About the Science Podcast   Authors: Kevin McLean, Andrew Zaleski, Zakiya Whatley   Episode Page: https://www.science.org/doi/10.1126/science.z1jhbqi   About the Science Podcast: https://www.science.org/content/page/about-science-podcast   [Image: Matt Roth, Music: Jeffrey Cook and Nguyen Khoi Nguyen] Learn more about your ad choices. Visit megaphone.fm/adchoices

First up this week, guest host Kevin McLean talks to freelance writer Andrew Zaleski about recent advancements in the world of synthetic blood. They discuss some of the failed attempts over the past century that led many to abandon the cause altogether, and a promising new option in the works called ErythroMer that is both shelf stable and can work on any blood type.   Next on the episode, producer Zakiya Whatley talks to Aaron Weimann from the University of Cambridge about the evolutionary history of the deadly bacterial pathogen Pseudomonas aeruginosa. They discuss how more than a century's worth of samples from all over the world contributed to new insights on the emergence and expansion of the pathogen known for its ability to develop antimicrobial resistance.   This week's episode was produced with help from Podigy.   About the Science Podcast   Authors: Kevin McLean, Andrew Zaleski, Zakiya Whatley   Episode Page: https://www.science.org/doi/10.1126/science.z1jhbqi   About the Science Podcast: https://www.science.org/content/page/about-science-podcast   [Image: Matt Roth, Music: Jeffrey Cook and Nguyen Khoi Nguyen] Learn more about your ad choices. Visit megaphone.fm/adchoices

My Results With GI Mapping: Addressing Digestive Issues and Food Allergies Click Here for a FREE 15 min Zoom Consultation With Brad: Over 40 Fitness Hacks Facebook Group Step By Step Podcasting Link! Descript Editing Software Link! www.Over40FitnessHacks.com In this episode of Over 40 Fitness Hacks, host Brad Williams discusses his recent experience with a GI mapping test. After suffering from a severe stomach flu that led to unexpected food allergies to chicken and eggs, Brad pursued a GI mapping test recommended by his DPC (Direct Primary Care) doctor to investigate ongoing digestive issues. Brad explains how the GI mapping test works, involving a stool sample analyzed for various bacteria levels, both good and bad. His results indicated an overgrowth of H. pylori, along with other bacteria like Morganella, Pseudomonas, and Streptococcus, though not at dangerous levels. His test also showed a low score in digestive enzymes, indicating poor nutrient absorption, and a high immune response marker due to the H. pylori infection. Given the options of antibiotics or a supplement regimen to address these issues, Brad chose the supplement route to avoid disrupting his gut microbiome further. He plans to retest in two months using a breath test for H. pylori and will journal his progress. Brad emphasizes the importance of seeking multiple medical opinions and exploring both traditional and holistic approaches to health. He concludes by expressing optimism about future advancements in the fitness and health industry, driven by AI technology, and offers a free 15-minute consultation for listeners. He plans to update listeners on his progress in a future episode. If you're interested in online personal training or being a guest on my podcast, "Over 40 Fitness Hacks," you can reach me at brad@over40fitnesshacks.com or visit my website at: www.Over40FitnessHacks.com Additionally, check out my Yelp reviews for my local business, Evolve Gym in Huntington Beach, at https://bit.ly/3GCKRzV

   Join us on War Docs as we welcome Army Physician MAJ Mary Ford, an infectious disease specialist and lead author of the acclaimed Military Medicine Journal's article of the year: Clinical Characteristics and Resistance Patterns of Pseudomonas aeruginosa Isolated From Combat Casualties https://pubmed.ncbi.nlm.nih.gov/34196358/    Listen in as MAJ Ford shares the impactful findings of her team's research on Pseudomonas aeruginosa in combat casualties, a topic of paramount importance to military health. Her personal journey into the infectious disease field, spurred by early curiosities and familial influences, and the progression of her military career make for a captivating story of dedication and passion.       In this engaging conversation, we also tackle the critical subject of infection prevention and antimicrobial stewardship in the face of combat trauma. Hear about the vital role of simple measures, like hand hygiene, in combating infections, especially those caused by the antibiotic-resistant Pseudomonas aeruginosa. Discover how MAJ Ford's team utilized the Trauma Infectious Disease Outcomes Study to uncover that approximately 6% of combat trauma patients developed Pseudomonas infections. The implications of these findings are vast, offering significant advancements for clinical outcomes and infection control in military medical settings. Tune in for a deep understanding of how such research continues to shape practices and policies within the Department of Defense.   Chapters: (00:02) Infectious Disease in the Military (07:12) Combat Trauma Infections and Pseudomonas   Chapter Summaries: (00:02) Infectious Disease in the Military  MAJ Mary Ford's research on Pseudomonas aeruginosa in combat casualties and its impact on military health, her personal journey into infectious disease, and the enduring need for ongoing research in the Department of Defense.   (07:12) Combat Trauma Infections and Pseudomonas   Infection prevention and antimicrobial stewardship are crucial in controlling Pseudomonas infections in combat trauma patients.   Take Home Messages: In the context of military medicine, the issue of infections following combat trauma is a significant concern, with Pseudomonas aeruginosa identified as a noteworthy pathogen due to its prevalence in prolonged hospital stays and its intrinsic antibiotic resistance mechanisms. Infection prevention and antimicrobial stewardship are critical components in the management of combat trauma infections. Basic practices such as hand hygiene play a pivotal role in controlling the spread of infections and can have substantial impacts on patient outcomes. Research conducted through the Trauma Infectious Disease Outcomes Study (T-DOS) has revealed that about 6% of combat trauma patients develop Pseudomonas infections, which underscores the importance of understanding and addressing these infections to improve clinical practices and infection control protocols. Combat trauma patients with Pseudomonas infections often experience lengthy hospital stays and intensive care unit admissions, highlighting the need for robust infection prevention strategies in military healthcare settings to reduce the burden of these nosocomial infections. The fight against infections like Pseudomonas aeruginosa in military medicine is an ongoing challenge that requires continuous research and evidence-based practices to ensure the health and readiness of military personnel. Basic infection control measures remain foundational in mitigating infectious threats.   Episode Keywords:  Military Medicine, Infectious Disease, Pseudomonas aeruginosa, Combat Trauma, Antimicrobial Stewardship, Research, Clinical Practices, Infection Control, Military Health, Nosocomial Pathogen, Antibiotic Resistance, Retrospective Analysis, Prospectively Collected Data, Trauma Infectious Disease Outcomes Study, Clinical Outcomes, Infection Prevention, Military Medical Environments Hashtags: #wardocs #military #medicine #podcast #MilMed #MedEd #MilitaryMedicine, #PseudomonasAeruginosa, #CombatInfections, #InfectiousDiseases, #AntimicrobialStewardship, #WarDocsPodcast, #MilitaryHealthcare, #TraumaInfections, #InfectionPrevention, #ClinicalResearch   Honoring the Legacy and Preserving the History of Military Medicine   The WarDocs Mission is to honor the legacy, preserve the oral history, and showcase career opportunities, unique expeditionary experiences, and achievements of Military Medicine. We foster patriotism and pride in Who we are, What we do, and, most importantly, How we serve Our Patients, the DoD, and Our Nation.   Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast   Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm   WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you.   WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms.     Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast  

What are WHO's most wanted bacterial pathogens in 2024? Hosts Angela Huttner & Oana Sandulescu welcome guests Dr. Hatim Sati of the World Health Organisation (WHO) and Dr. Erin Duffy (CARB-X) to discuss WHO's new Priority Pathogens List. Developed by WHO and a panel of global experts, the List identifies the ‘top' bacteria for which research & development are of critical, high, and medium priority, and thus serves as a framework for resource allocation and public-policy guidance. Episode peer-reviewed by Dr. Galadriel Pellejero of Lozano Blesa Clinical Hospital, Zaragoza, Spain. Literature:WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance.https://www.who.int/publications/i/item/9789240093461

TWiV rebuts a recent opinion piece which falsely claims that the COVID-19 pandemic began in a lab (it began in Nature), followed by a discussion of Paride bacteriophage, which has the unsual property of being able to kill dormant, antibiotic-tolerant cells by direct lytic replication. Hosts: Vincent Racaniello, Alan Dove, Rich Condit, Brianne Barker, and Jolene Ramsey Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server 2024 International HBV Meeting Register for ASV Annual Meeting SARS-CoV-2 origin discussions previously on TWiV: TWiV 1019: Eddie Holmes on SARS-CoV-2 origins TWiV 1017: From Nature, not a lab TWiV 995: Viral origin stories TWiV 940: Eddie Holmes in on viral origins TWiV 876: Spillover market with Michael Worobey TWiV 762: SARS-CoV-2 origins with Robert Garry TWiV 760: SARS-CoV-2 origins with Peter Daszak, Thea Kølsen Fischer, Marion Koopmans TWiV 774: Kristian Andersen, Robert Garry, and the deleted SARS-CoV-2 sequences Why the Pandemic Probably Started in a Lab, in 5 Key Points (NY Times) Phage Paride kills dormant, antibiotic-tolerant cells of Pseudomonas aeruginosa (Nat Comm) Interview with Enea Maffei (Spotify) Timestamps by Jolene. Thanks! Weekly Picks Brianne – How to build a nuclear warning for 10,000 years' time Rich – Doctor My Eyes | Jackson Browne Alan – WHO Health for All Film Festival winners Jolene – El enemigo de mi enemigo es mi amigo Vincent – A Population Dotmap of New York City and Race and Ethnicity in New York City Listener Picks David – The greatest clock (and map) ever made Peter – The Mouse as a Microscope Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv

Klebsiella, Streptococcus, Pseudomonas, oh my! Have you been told that your gut symptoms are related to these opportunistic pathogens based on popular stool testing? Has your provider suggested antibiotics or herbal antimicrobials for these bugs? If so, then this episode is for you! Join the gals as they discuss the best strategies to address these opportunistic bugs and bring back balance to your microbiome. 

Today, Dr. Jo Handelsman of the University of Wisconsin Madison and Director of the Wisconsin Institute for Discovery joins the #QualityQuorum to discuss the work she and her research collaborators do on interactive microbial communities, using THOR (the hitchhikers of the rhizosphere) as a model system.  She will also remind us how vital soil is to our lives. Host: Mark O. Martin Guest: Jo Handlesman Subscribe: Apple Podcasts, Spotify Become a patron of Matters Microbial! Links for this episode An article on the story of “uranium glass,” that fluoresces under ultraviolet light.  Here is another interesting article on the topic.   The website for Hartiful, who makes custom enamel pins (including some that glow in the dark, as all cool things should). Giant Microbes makes small and large plush toys of microbes and other biology related items. An overview of ice nucleation proteins.  Here is a more technical article on the topic. The story of SNOWMAX. Ice nucleation proteins and snowflakes. One of my favorite videos from my microbiology class in 2008, demonstrating ice nucleation by Pseudomonas syringae.   The website for the Tiny Earth antibiotic crowdsourcing CURE. The website for Dr. Handelsman's book, “A World Without Soil.” An explainer of THOR, for new micronauts. A technical publication from Dr. Handelsman's research group on THOR. An explainer of microbial “zorbs,” for new micronauts. A technical publication from Dr. Handelsman's research group on “zorbs.” Dr. Handelsman's page on Wikipedia. Dr. Handelsman's faculty page. Dr. Handelsman's research website. Intro music is by Reber Clark Send your questions and comments to mattersmicrobial@gmail.com

News: Isolation of aerobic bacteria from abscesses and wounds in rabbits and antibiotic susceptibility testing of Staphylococcus spp. and Pseudomonas spp. isolates. Main Topic: Mouth issues in freshwater turtles Mouth issues are commonly seen in pet freshwater turtles. We discuss why this occurs and how to treat and prevent. Do you see mouth issues in turtles? VetGurus Merchandise - VetGurus Etsy Store VetGurus Shop Checkout the VetGurus range of quirky, distinctive branded items. All purchases help support our podcast , helping pay for our production costs. So the bonus for you is that you get some great merchandise and you feel good inside for supporting us - win:win. So click on this link and get shopping. Order now: VetGurus Shop. Say Hi! Send us an email: VetGurus@Gmail.com. We love hearing from our listeners - give us a yell now! Become a Patron Become a Patron of VetGurus: Support us by 'throwing a bone' to the VetGurus - a small regular donation to help pay for our production costs. It's easy; just go to our Patreon site. You can be a rabbit.. or an echidna.. one day we are hoping for a Guru level patron! https://www.patreon.com/VetGurus Support our Sponsors Microchips Australia: Microchips Australia is the Australian distributor for: Trovan microchips, readers and reading systems; Lone Star Veterinary Retractor systems and Petrek GPS tracking products. Microchips Australia is run by veterinarians experienced in small and large animal as well as avian and exotic practice, they know exactly what is needed for your practice. Specialised Animal Nutrition. Specialised Animal Nutrition is the Australian distributor of Oxbow Animal Health products. Used and recommended by top exotic animal veterinarians around the globe,  the Oxbow range comprises premium life-staged feeds and supportive care products for small herbivores. Chemical Essentials. Cleaning and disinfection products and solutions for a wide variety of industries throughout Australia, as well as specific markets in New Zealand, Singapore and Papua New Guinea. The sole importer of the internationally acclaimed F10SC Disinfectant and its related range of advanced cleaning, personal hygiene and animal skin care products. About Our Podcast The veterinary podcast about veterinary medicine and surgery, current news items of interest, case reports and anecdotes. Wait: It's not all about veterinary matters! We also discuss other areas we are passionate about, including photography and wildlife. Thanks for joining us - Brendan and Mark. Our podcast is for veterinarians, veterinary students and veterinary nurses/technicians. If you are at pet owner please search elsewhere - there are lots of great podcasts aimed specifically at pet owners. Disclaimer Any discussion of medical or veterinary matters is of a general nature. Consult a veterinarian with experience in the appropriate field for specific information relating to topics mentioned in our podcast or on our website.

In this week's issue: Learn about the geographic distribution of oculofacial plastic surgeons and its correlation to socioeconomic demographics in the United States. A case series of patients with Pseudomonas aeruginosa keratitis shows increasing resistance and virulence and suggests a novel new therapeutic approach. A new model predicts axial length in children after bilateral cataract surgery to customize intraocular lens selection for the best visual outcomes. Proteomic profiles of aqueous fluid in those with diabetic retinal disease show signs of inflammation and neuronal dysfunction prior to clinical findings of retinopathy.

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

This episode discusses four MMWR reports. First, cannabis use dropped among students, particularly male students, in King County, Washington. Second, inadequate chlorine levels in a hotel pool likely led to a water-associated Pseudomonas outbreak in Maine. Third, wastewater monitoring detects even low levels of mpox in communities. Finally, mpox transmission in Los Angeles County, California, increased during the summer of 2023 compared with previous months.

We managed to make it through 2023 without a major epidemic or pandemic, and as we get into the holiday spirit and look forward to the new year, some of us took a look back and picked out one of our favorite JCM paper published in 2023, which I will tell you, was no easy task as there were many of good ones to choose from! And personally, after looking through all the issues over the last year, it never ceases to amaze me the variety of topics that we publish on in JCM – including unique things like the evaluation of a molecular assay for diagnosis of Buruli ulcers, to development of an EIA for detection of Taenia coproantigen, and then of course we have the more bread and butter things like evaluation of new assays for detection of TB resistance, to multiple studies this year on women's health diagnostics, and evaluation of new molecular assays for congenital CMV detection, and then I'm also told that there were some awesome AST-focused papers too, which is all just great. The four of us JCM editors have selected the following favorite papers of ours from the past year:   Whole-Genome Subtyping Reveals Population Structure and Host Adaptation of Salmonella Typhimurium from Wild Birds | Journal of Clinical Microbiology (asm.org) Detailed β-(1→3)-D-glucan and mannan antigen kinetics in patients with candidemia | Journal of Clinical Microbiology (asm.org) Interlaboratory comparison of Pseudomonas aeruginosa phage susceptibility testing | Journal of Clinical Microbiology (asm.org) Emergence of Inducible Macrolide Resistance in Mycobacterium chelonae Due to Broad-Host-Range Plasmid and Chromosomal Variants of the Novel 23S rRNA Methylase Gene, erm(55) | Journal of Clinical Microbiology Commentary: Plasmid-mediated drug resistance in mycobacteria: the tip of the iceberg? | Journal of Clinical Microbiology Guests: Melissa Miller, Ph.D., D(ABMM), FAAM, University of North Carolina Medical Center Patricia Simner, Ph.D., D(ABMM), Johns Hopkins University School of Medicine This episode of Editors in Conversation is brought to you by the Journal of Clinical Microbiology and hosted by JCM Editor in Chief, Alex McAdam and Dr. Elli Theel. JCM is available at https://jcm.asm.org and on https://twitter.com/JClinMicro. Visit journals.asm.org/journal/jcm to read articles and/or submit a manuscript.

In collaboration with Saudi Pediatric Infectious Diseases Society and the King Abdulaziz Public Library, Febrile episodes 86-88 are coming to you live from Riyadh!In the first of three episodes, listen to Dr. Efteraj Alhowity Dr. Bashayer Alshehail discuss MDR/DTR-Pseudomonas aeruginosa and carbapenemases from a global perspective.Episodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.com

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

In this episode, Emily Heil, PharmD, MS, BCIDP, AAHIVP; Laila Woc-Colburn, MD; and Trevor Van Schooneveld, MD, FSHEA, FACP, discuss their approach to managing infections involving Pseudomonas aeruginosa with difficult-to-treat resistance, including: Mechanisms of β-lactam resistanceEffect of resistance mechanism on susceptibility to antipseudomonal agent2023 IDSA guidance recommendations Activity against newer antipseudomonal β-lactams in the United StatesThe latest clinical data by antimicrobial regimen:              - Ceftolozane/tazobactam              - Ceftazidime/avibactam              - Imipenem/cilastatin/relebactam              - CefiderocolApplying antimicrobial stewardship principlesProgram Director:Trevor Van Schooneveld, MD, FSHEA, FACP  Professor, Division of Infectious DiseasesProgram Director, Infectious Diseases FellowshipMedical Director, Antimicrobial Stewardship ProgramUniversity of Nebraska Medical CenterOmaha, NebraskaFaculty:Emily Heil, PharmD, MS, BCIDP, AAHIVPAssociate ProfessorDepartment of PharmacyUniversity of Maryland  School of PharmacyID Clinical Pharmacy SpecialistUniversity of Maryland Medical Center|Baltimore, MarylandLaila Woc-Colburn, MDAssociate ProfessorDivision of Infectious DiseasesEmory University School of Medicine  Atlanta, GeorgiaContent based on a CME program supported by an educational grant from Merck & Co., Inc., Rahway, NJ, USA.Follow along with a downloadable slideset at: https://clinicaloptions.com/CE-CME/infectious-disease/cmv-prevention-in-sot-recipients/26139Link to full program: https://bit.ly/40HyvPy 

Ear cultures are a bit controversial in veterinary dermatology. Do you know why? Check out this week's episode of The Derm Vet podcast to find out!

TWiM discusses a dispute about whether the mycobiome plays a role in the development of cancer, and the structure and function of channels that are delivered to plant cells by pathogenic bacteria. Hosts: Vincent Racaniello, and Michael Schmidt. Become a patron of TWiM. Links for this episode Cancer microbes disputed (Carl Zimmer) Fungal mycobiome and cancer (Nature) Revisiting fungal mycobiome and cancer (Nature) Bacteria deliver channels to plant cells (Nature) Ice nucleation by bacteria (YouTube) Gram-negative bacterial porins (Curr Protein Pept Sci) Xenopus oocyte toolbox (Cold Spring Harb Protocols) Take the TWiM Listener survey! Send your microbiology questions and comments (email or recorded audio) to twim@microbe.tv

On episode #37 of the Infectious Disease Puscast, Daniel reviews the infectious disease literature for the weeks of 8/31 – 9/13/23. Host: Daniel Griffin and Sara Dong Click arrow to play Download Puscast 037 (22 MB .mp3, 31 min) Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Association between varicella zoster virus and dementia (NS) Safety, efficacy, and immunogenicity of V160 vaccine in cytomegalovirus-seronegative women (The Lancet) Microorganisms detected in intussusception cases and controls in children (OFID) Clinician testing and treatment thresholds for management of UTIs (OFID) Clinical outcomes and management of NAAT-positive/toxin-negative Clostridioides difficile infection (CID) Associations of standard care, intrathecal antibiotics, and antibiotic impregnated catheters with cerebrospinal fluid shunt infection (JPIDS) Advances in asynchronous telemedicine call for increased antibiotic surveillance (CID) Two artificial tears outbreak-associated cases of extensively drug-resistant Pseudomonas aeruginosa detected through whole genome surveillance (JID) Pre-XDR congenital TB in an extremely premature baby (CID) Emerging Roles of (1→3)-β-D-glucan in cerebrospinal fluid for detection and therapeutic monitoring of fungal diseases (CID) Outbreak of locally acquired mosquito-transmitted malaria (CDC) Complexity of infectious diseases compared to other cognitive medical subspecialties (OFID) Risk of opportunistic infections associated with long-term glucocorticoid therapies in adults (CID) Music is by Ronald Jenkees

TWiM explains personalized aerosilized phage therapy for a chronic lung infection, and using the combination of antibiotic and a DNA molecule that binds alpha-gal to reduce S. aureus infection in vivo. Hosts: Vincent Racaniello and Michael Schmidt Subscribe to TWiM (free) on Apple Podcasts, Google Podcasts, Stitcher, Android, RSS, or by email. Become a Patron of TWiM! Links for this episode: Aerosolized phage therapy (Nat Comm) Alpha-gal aptamer and vancomycin for MRSA (Microorg) Alpha-gal syndrome (Front Allergy) Natural antibody protects against viral infection (virology blog) Music used on TWiM is by Ronald Jenkees. Send your microbiology questions and comments to twim@microbe.tv

Welcome to another exciting episode of Talking Pools Podcast! I'm your host, Rudy, joined by my co-host Andrea, and today we have two brilliant expert guests delving into an important and timely subject - waterborne infectious diseases in the United States. Joining us are Roy Vore, a renowned microbial physiologist from Vore and Associates, and Jenn Huang, a distinguished chemist and owner of ApothaQuali Solutions. Together, we'll be diving into the eye-opening findings from the article "Estimating Waterborne Infectious Disease Burden by Exposure Route, United States, 2014." Get ready to explore the staggering statistics. Let's jump right in! AquaStar Pool Products The Global Leader in Safety, Dependability, & Innovation in Pool Technology.POOL MAGAZINE Pool Magazine is leading up to the minute news source for Swimming Pool News and Pool Features. OuBLUERAY XL The real mineral purifier! Reduce your pool maintenance costs & efforts by 50%NC Pro Training FREE online/virtual training with NC Brands!Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the show

In 2022, a mysterious outbreak of a deadly drug-resistant bacteria began spreading across several U.S. states. A CDC investigation would eventually reveal an unusual culprit: common eye drops. In this episode, Dr. Danielle Rankin takes us behind the scenes of the investigation, sharing how they made their big break and what we've learned as a result. Dr. Rankin is an epidemiologist for the Antimicrobial Resistance Team in the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention. Prior to pursuing her PhD, she was an epidemiologist for the Florida Department of Health Healthcare Associated Infections Program. Dr. Rankin has published 28 manuscripts and throughout her career has conducted over 70 infection control assessments and investigated more than 60 domestic infectious disease outbreaks. For full episode transcription, visit Contagious Conversations.   Key Takeaways: [1:37] When did CDC first learn about the Pseudomonas aeruginosa infections? [2:58] What led to discovering the bacteria transmitted through eye drops? [4:30] What was Dr. Rankin's first big break in this investigation? [6:42] What do we know about this bacteria and its origin? [8:25] Bacteria like these are constantly evolving to resist antibiotic treatment; Dr. Rankin talks about the cause of antibiotic resistance and the role of CDC in researching solutions. [10:08] Dr. Rankin talks about the role of CDC on a global scale. [10:39] What steps does CDC take when an outbreak like this occurs? [12:42] Why are partnerships critical in responding to outbreaks? [13:40] What is the outbreak investigation state currently? Do any threats remain? [15:48] Has anything surprised Dr. Rankin about this particular outbreak? [17:33] How is CDC preparing to meet the challenge of future outbreaks?    Mentioned in This Episode: CDC's Division of Healthcare Quality and Promotion  

Pseudomonas otitis is one of the toughest issues we face in veterinary dermatology. What do these cases look like? What do these cases need topically and systemically? What ingredients should be in the ear flush?Back to interviews on the podcast (my favorite!), I am joined by Amelia White, DVM, MS, DACVD from Auburn University. Listen into our discussion about this difficult case and gain tips on how to be successful with treatment on this week's episode of The Derm Vet podcast!

The Case:  Mira has Hashimoto's and also suffers from digestive issues.  These issues are long-standing and doctors or dietary changes have been ineffective Researching online has her feeling overwhelmed and lost.  There's so much confusing information online and when that is paired with a doctor telling you that there is nothing to be done or that tests show no issues, it leaves many Hashimoto's patients suffering from gut issues resigned to never feeling good again. That's why I was so glad that Mira came to me so we could do some real investigating to find the root cause of her digestive issues.  The Investigation I turned to a good friend of the Health Mysteries Solved show, Evan Brand. He is a functional medicine doctor and he also has his own podcast, The Evan Brand Show. He's shared his expertise with us before, if you haven't listened to episode 6, I encourage you to go back and give it a listen - it was a very eye-opening look at the hidden risks of mold. We discussed mold in this episode as well but I wanted to start our conversation talking about digestive issues for those with hypothyroidism and Hashimoto's.  Digestive Issues Triggering Autoimmunity (including Hashimoto's) May Start in Childhood We don't often think about the relationship between our gut health and our immune system but they are incredibly connected. Evan shares that some of these issues start at a very early age. Evan believes it is crucial to address children's gut health as resolving these issues early on may help prevent the development of Hashimoto's and other autoimmune conditions in their teenage and adult years. He specifically points to autoimmune-triggering bacteria such as Klebsiella, Morganella, Strep, Staph, and Pseudomonas, which have been linked to various autoimmune conditions.  Evan encourages parents to consider gut health as a potential cause for behavioral issues, hyper-sensitivities, attention challenges, or other personality changes that could easily be presumed to be ADHD, OCD, or personality quirks. These could in fact, says Evan, be signs of a bacterial imbalance, parasites, or mold toxicity. He stresses the importance of dealing with these issues early because they can develop into long-term consequences such as anxiety, depression, chronic fatigue, weight issues, sleep problems, behavioral issues, and learning difficulties as they grow older. Evan also notes that dysbiosis, an imbalance of gut bacteria, can occur at a young age, regardless of whether the child was born via C-section or vaginal birth. Lyme Disease and Babesiosis As Autoimmunity Triggers Evan also notes that babies can contract Lyme disease through the placenta of an infected mother or directly through a tick bite. He notes that tick bites are a growing problem.  Evan points to a recent statement from the CDC called Trends in Reported Babesiosis Cases which points to the significant increase in babesiosis cases from 2011 to 2019. Interestingly, he says that if cases go undiagnosed, these issues could be the cause of Hashimoto's.  This concept aligns with what we talk about all the time on this show regarding the triggers of Hashimoto's including bacterial overgrowth, stress, and mold or toxin exposure. Evan explains that addressing these underlying issues often leads to a decrease in antibodies associated with Hashimoto's, highlighting the domino effect of these interconnected health conditions. Are Hashimoto's and Autoimmunity a Purely Modern Health Threat Evan and I discuss how our ancestors may have dealt with these infections and pathogens in the past. While these issues likely existed, they weren't as prevalent due to differences in environmental factors, stress levels, and exposure to chemicals and technology. Our modern lifestyles contribute to chronic inflammation and dysbiosis, leading to the autoimmune misery we see today. It's important to address these root causes, including gut health, to alleviate symptoms and improve overall well-being. Testing for Hidden Causes of Ill-Health Diagnosing dysbiosis, infections, and autoimmune diseases requires tests that go beyond what a conventional doctor (or even a gastroenterologist or endocrinologist) will order. Evan suggests combining DNA stool testing with an organic acids test (if budget permits), as it provides a broader picture of gut health and mitochondrial function. These are exactly the tests I recommend to my clients because these advanced tests allow us to uncover underlying infections, dysbiosis, and other issues that may be contributing to autoimmune conditions like Hashimoto's. Where to Start in Solving Dysbiosis and Other Potential Hashimoto's Triggers Comprehensive testing, as mentioned above, is the key to knowing where to start. In most cases, treatment begins with dietary changes, supplements, as well as lifestyle changes. However, even with these actions, if the root cause of the issue is not addressed, the issues will pop back up eventually. This is why it's so important to find the root cause and address it.  If gut issues go untreated or under-treated, it can also lead to low energy levels, poor fat metabolism, anxiety, reduced sex drive, and lower self-confidence. This can create stress which further exacerbates the issues. This is why it's so important to get the tests and treat the root cause, not the symptoms. This is especially true if mold is the root cause.  The Impact of Mold in Our Homes and on Our Health Mold is more than just a cosmetic issue; it can have a significant impact on our well-being. Mold spores can trigger allergic reactions, and respiratory issues, and even contribute to chronic conditions. Recognizing the potential health risks associated with mold exposure is the first step toward protecting ourselves and our loved ones. To test your home for mold, Evan suggests using the petri dish method because it allows you to identify specific rooms in the home where mold issues exist. For example, you may find that the basement has the highest concentration of spores but that your daughter's bedroom is fine. This allows you to treat specific areas and not feel like your entire house is hurting you. This is important because the stress of thinking that your entire house is a threat to your health can have a serious impact on your stress levels which can also impact your thyroid.  It's so important to know that mold can be mitigated and the impact of the mold in your home can be managed. Not panicking and dealing with the issues calmly are an important part of staying healthy through this issue.  In addition, doing stool and urine tests can help you track the impact of mold and the results of removing the mold.  How to start addressing gut infections and underlying mold In this episode, we discussed many protocols for addressing bacterial and parasitic infections and gut inflammation. There are many over-the-counter options but ultimately, it's ideal to work with a holistic practitioner for personalized guidance.  If you want to take action on your own, Evan suggests using binders as a starting point, considering the prevalence of toxins, chemicals, pesticides, and mold in today's world. He mentions that binders are generally safe and necessary for detoxification but suggests not just using charcoal - a blend of binders is more effective.  There are many options but he recommends the GI detox. The GI detox is a blend of zeolite, charcoal, silica, pectin, and fulvic or humic acid. Evan explains that this blend effectively binds various toxins. Zeolite, for example, is effective for heavy metals, while the clay component specifically targets a highly estrogenic mycotoxin called Xarelanone, which originates from the mold Fusarium commonly found in water-damaged buildings. Xarelanone can disrupt female hormones, leading to infertility, miscarriages, and fetal abnormalities. The presence of Xarelanone can be detected through a urine test (organic acids test).  A Caution About Using Probiotics with Hashimoto's and Histamine Intolerance Probiotics are also important in dealing with a mold detox. However, many Evan finds that Hashimoto's patients tend to have histamine-producing bacterial overgrowth, which can contribute to food sensitivities and mast cell issues. For this reason, he utilizes low histamine strains of bacteria in their protocols. He mentions that they now incorporate probiotics right from the beginning, as they have discovered that certain probiotics can actually convert mold into less damaging forms. Evan mentions a blend called ProBio 50 that he has reviewed with Dr. Tanya Dempsey, an expert in mast cell issues. He explains that according to Dr. Dempsey, Bifidolactis and Lactobacillus Acidophilus, which are included in the blend, are considered low histamine strains.  On the other hand, he believes that strep strains typically fall into the high histamine category. Evan acknowledges that more research can be done to confirm these categorizations, but he has found success using the ProBio 50 blend with even the most sensitive individuals, as opposed to spore-based products which can elicit histamine reactions in some people. It's important to note that spore-based probiotics may work well for individuals with SIBO, others may react negatively due to their unique biochemistry. This highlights the importance of individualized approaches in selecting the right probiotics for each person's specific needs and sensitivities. Here is a list of probiotic strains that are both histamine-increasing and lowering.  Histamine-increasing strains: Lactobacillus Casei Lactobacillus Bulgaricus Streptococcus Thermophilus Lactobacillus Delbrueckii Lactobacillus Helveticus Lactobacillus Reuteri Histamine-lowering strains: Lactobacillus Plantarum Bifidobacterium Longum - helps improve gut barrier and assists in histamine degradation Bifidobacterium Infantis Lactobacillus Rhamnosus Lactobacillus Reuteri is one of the most common strains that increase histamines and should be avoided by those with histamine intolerances. Balancing Treatments to Ensure Optimal Results While it might seem obvious to use a low histamine-producing probiotic if you have histamine intolerance, Evan explains that balance is the key. Using histamine-reducing probiotics alongside histamine-producing ones can create a balance. In addition to probiotics during a mold detox, it's also important to support the adrenals and liver. His recommendations include milk thistle and medicinal mushrooms such as chaga and turkey tail, which are considered immune-modulating formulas. Evan emphasizes the significance of adaptogenic herbs for hormonal support, particularly in women above the age of 40. He says herbs such as Rhodiola, maca, and Siberian ginseng can help the body cope with stress. These adaptogens can also address issues like temperature regulation, such as feeling cold all the time or experiencing hot flashes. Evan shares that incorporating these herbs into the protocol can improve the individual's ability to tolerate temperature changes and engage in activities without feeling faint or woozy. Of course, it's important to have a holistic approach when designing protocols, focusing not only on immediate improvements but also on long-term solutions. This includes addressing environmental factors such as mold, toxins, and synthetic fragrances in the home, as well as adopting a clean and organic lifestyle.  The final piece of the puzzle is maintaining a positive mindset, fostering relationships, and engaging in activities that bring joy and a sense of connection. This can be what tips the scales to optimal health.  Next Steps  There is so much that you can do to unravel the mystery of your symptoms by looking at some of the most common triggers. Especially if you have digestive issues on top of autoimmunity, you really can't go wrong by starting in the gut. That's exactly what Mira and I did. We ran a DNA stool test and an organic acid test. We found that she had quite a bit of dysbiosis. We also found that there was fat in the stool so we used bitters and Advanced TUDCA to increase bile production. This also helped to reduce pain during bowel movements.  We started Mira on the binder Evan mentions, GI Detox but I also rotated in Biotoxin Binder.  We added anti-fungals and anti-microbials, GI MicrobX, Allimax, Oil of Oregano, FC Cidal, and Dysbiocide. This was to address the specific infections found in her gut.  Mira also had a parasite so we used Para 1 and Para 2 which we timed around the full moon.  It's important to note that initially, this made Mira feel worse but that is part of the die-off process and soon, she was feeling much better.  We added more fiber to her diet by increasing her vegetable intake which helped with diversifying her gut. We also exposed her to many different probiotic strains including probiotic 225 and PriobioMed 50. After that, we used Entrovite (a post-biotic) to improve the diversification and find that balance of good and bad gut bugs.  Happy Ending There's no question that Mira needed serious support to get her gut health back to happy. Once we found that happy balance in her gut, her Hasimoto's antibodies dropped, her energy improved and she lost weight.  Eliminating Health Mysteries For Mira, we were able to find that missing piece of the health puzzle and help her regain her health. Could this be the missing clue for you or someone in your life?  Links: Resources mentioned: Thanks to my guest Evan Brand. You can connect with him through his website: www.EvanBrand.com Evan referenced a histamine expert named Lindsay Christensen from Ascent to Health. He also referenced the Trends in Reported Babesiosis Cases — United States, 2011–2019 | MMWR (cdc.gov) from the CDC.    Suggested Products GI Detox Para 1 Para 2 Advanced TUDCA Biotoxin Binder GI MicrobX Allimax Oil of Oregano FC Cidal Dysbiocide Related Podcast Episodes: 6 The Case of the Dizzy, Tired, Confused Brain w/ Evan Brand 81 The Mystery of Histamine Overload w/ Dr. Beth O'Hara 137 Are You Ignoring an Important Connection Between Gluten, Your Gut, and Hashimoto's? Thanks for Listening If you like what you heard, please rate and review this podcast. Every piece of feedback not only helps me create better shows, it helps more people find this important information. Never miss an episode -  Subscribe NOW to Health Mysteries Solved with host, Inna Topiler on Apple Podcasts, Spotify, Stitcher or Google Podcasts and remember to rate and review the show! Find out more at http://healthmysteriessolved.com PLEASE NOTE All information, content, and material on this podcast is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Some of the links provided are affiliate links. This means we may make a very small amount of money should you choose to buy after clicking on them. This will in no way affect the price of the product but it helps us a tiny bit in covering our expenses.  

Scientists are puzzled by a recent study that found the average erect penis length has increased by 24 percent worldwide over the last few decades. The researchers speculate that global environmental causes, including a sedentary lifestyle and exposure to hormone-disrupting substances, could be contributing to the increase. A man in his 50s diagnosed with prostate cancer developed an "uncontrollable 'Irish accent" despite not having one before, according to a report by researchers from Duke University and Carolina Urologic Research Center. The researchers suspect that the man's case is a rare instance of Foreign Accent Syndrome, which basically means that your speech changes in a way that makes it sound like you have a foreign accent. And in this case, it was the luck of the Irish. Apparently, the CDC has tied the use of EzriCare Artificial Tears to a multi-state cluster of Pseudomonas aeruginosa patients. The CDC is investigating at least 50 cases in 11 states that have led to hospitalization, permanent vision loss, and even one death. Yikes. For WHAT THE HELLTH Jer shows us a wild simulation of what it feels like to live with schizophrenia and let's just say it's not not scary. Join the post-episode conversation over on Discord! https://discord.gg/expeUDN