Podcasts about Refractory

Refractory hypoxemia in the intubated patient is one of the scariest situations any emergency physician can face. In this episode of EMRA*Cast, Drs. Peter Lorenz and Steven Haywood discuss a stepwise approach to managing this worst-case scenario.

Emergency treatment may be necessary after a person's first seizure or at the onset of abnormal acute repetitive (cluster) seizures; it is required for status epilepticus. Treatment for these emergencies is dictated by myriad clinical factors and informed by published guidance as well as emerging research.   In this episode, Lyell K. Jones, MD, FAAN, speaks with David G. Vossler, MD, FAAN, FACNS, FAES, author of the article “First Seizures, Acute Repetitive Seizures, and Status Epilepticus,” in the Continuum® February 2025 Epilepsy issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Vossler a clinical professor of neurology at the University of Washington School of Medicine in Seattle, Washington. Additional Resources Read the article: First Seizures, Acute Repetitive Seizures, and Status Epilepticus Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ  Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Dave Vossler, who has recently authored an article on emergent seizure management, taking care of patients with the first seizure, acute repetitive seizures, and status epilepticus, which is an article in our latest issue of Continuum covering all topics related to epilepsy. Dr Vossler is a neurologist at the University of Washington, where he's a clinical professor of neurology and has an active clinical and research practice in epileptology. Dr Vossler, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Vossler: Thank you very much for the introduction, Lyell. It's a pleasure to speak with you on this podcast, and I hope to go over a lot of important new information in the management of seizure emergencies. As you said, I'm a clinical professor in neurology at University of Washington, been in medicine for many decades now and have published and done research in this area. So, I'm anxious to give you not only my academic experience, but also talk about my own management of patients with status epilepticus over the last four decades. Dr Jones: Yeah, that's fantastic. And I always appreciate hearing from experienced clinicians, and I think our readers and our listeners do appreciate that voice of clinical expertise. And I'll tell you this is a topic, you know, as a neurologist who doesn't see many patients with acute seizure emergencies in my own practice, I think this is a topic that gives many clinicians, including neurologists, some anxiety. Your article, Dr Vossler, is really chock-full of helpful and clinically relevant considerations in the acute management of seizures. So, you now have the full attention of a huge audience of mostly neurologists. What's the one most important practice change that you would like to see in the care of patients with either first or acute prolonged seizures? Dr Vossler: Without a doubt, the most important clinical takeaway with regard to the status epilepticus---and for status epilepticus, many, many clinical trials, research trials have been done over the last couple decades and they all consistently show the same thing, that by and large most patients who have status epilepticus are underdosed and undertreated and treated too slowly in the initial stages of the status epilepticus. And it's important to use full bolus dosages of benzodiazepines to prevent mortality, morbidity, and later disability of these patients. To prevent the respiratory depression, many physicians are afraid to use higher doses of benzodiazepines, even guideline-recommended doses of benzodiazepines for fear of respiratory depression. But it's actually counterintuitive. It turns out that most cases of respiratory depression are due to inadequate doses and due to the status epilepticus itself. We know there's greater mortality, we know there's greater morbidity and we know that there's greater need for higher dose, subsequent, anti-seizure medications, prolonged status, if we don't use the proper doses. So, we'll kind of go over that a little bit, but that is the one clinical takeaway that I really would like our listeners to have. Dr Jones: Let's follow that thread a little bit. Dave, I know obviously we will speak in hypotheticals here. We're not going to talk about actual patients, but I think we've all been in the clinical situation where you have a patient who comes into the emergency room usually who's actively seizing, unknown history, don't know much about the patient, don't know much about the circumstances of the onset of the seizure. But we now have a patient with prolonged convulsive seizures. How do we walk through that? What are the first steps in the management of that patient? Dr Vossler: Yeah, well, I'll try to be brief for the purposes of the podcast. We do, of course, go through all of that in detail in the Continuum article, which hopefully everybody will look at very carefully. Really in the first table, the very first table of the article, I go through the recommended guideline for the American Epilepsy Society on the management of what we call established status epilepticus. The scenario you're talking about is just exactly that: established status epilepticus. It's not sort of evolving or developing status. We're okay they're having a few seizures and we're kind of getting there. No, this patient is now having evidence of convulsive seizure activity and it's continuing or it's repeated seizures without recovery. And so, the first phase is definitely a benzodiazepine and then the second phase is then a longer-acting bolus of a drug like phosphenotoine, valproic acid or levetiracetam. I could get into the details about dosing of the benzodiazepines, but maybe I'll let you guide me on whether we wanted to get into that kind of detail right at the outset. It's going to be a little bit different. For children, its weight-based dosing, but for adults, whether you use lorazepam or you use diazepam or you use midazolam, the doses are a little bit different. But they are standardized, and gets back to this point that I made earlier, we're acting too slow. We're not getting these patients quick enough, for various reasons, and the doses that are most commonly used are below what the guidelines call for. Dr Jones: That's great to know, and I think it's fine for the details to refer our listeners to the article because there are great details in there about a step-by-step approach to the established status epilepticus. The nomenclature and the definitions have evolved, haven't they, Dr Vossler, over time? Refractory status epilepticus, new-onset refractory status epilepticus, super refractory status epilepticus. Tell us about those entities, how they're distinguished and how you approach those. Dr Vossler: That's an important thing to kind of go over. They- in 2015, the International League Against Epilepsy, ILAE, which is, again, our international organization that guides our understanding of all kinds of things epileptic in nature around the world. In 2015 they put out a definition of status epilepticus, but it used to be that patients had thirty minutes of continuous seizure activity or repetitive obvious motor seizures with impairment of awareness and they don't recover impairment between these seizures. And that goes on for thirty minutes. That was the old definition of status epilepticus. Now, the operational definition is five minutes. And I think that's key to understand that, after five minutes of this kind of overt seizure activity, you need to intervene. And that's what's called T1 in the 2015 guideline, the international guideline. There are a bunch of different axes in the classification of status that talk about semiology, etiology, EEG patterns, and what age group you're talking about. We won't really get into those in the Continuum article because that's really more detailed than a clinician really should be. Needing to think about the stages, what we call the stages of status epilepticus that you mentioned and I alluded to earlier are important. And that is sort of new nomenclature, and I think probably general neurologists and most emergency room physicians aren't familiar with those. So, it just briefly goes through those. Developing status epilepticus is where you're starting- the patient's starting to have more frequent seizures, and it's heading essentially in the wrong direction, if you will. Established status epilepticus, as I mentioned, is, you know, this seizure act, convulsive or major, major outward overt seizure activity lasting five minutes or more, at which time therapy needs to begin. Again, getting back to my point, what doesn't happen often enough is we're not- we're intervening too late. Third is refractory status epilepticus, which refers to status epilepticus which continues despite adequate doses of an initial benzodiazepine given parenterally followed by a full loading dose of a single non-sedating anti-seizure medicine, which today includes phosphenotoine IV valproic acid or IV levetiracetam. In the United States, and increasingly around the world, people really are using levetiracetam. First, it has some advantages. There's now proof from a class one NIH-funded trial. We know that these three drugs are equivalent at the full doses that I go over in the article. You have your kind of dealer's choice on those. Phenobarbital, which we used to use and I used as a resident as long as forty years ago, is really a second choice drug because of its sedating and other side effects. But around the world in resource-poor countries phenobarbital can be used and, in a pinch, certainly is an appropriate drug. And then finally, you mentioned super refractory status epilepticus and that's status that's persisting for more than twenty four hours. Now, despite initial benzo and non-sedating anti-seizure medicine, but also lasting more than twenty four hours while receiving an intravenous infusional sedating, anesthetizing anti-seizure medicine like ketamine, propofol, pentobarbital or midazolam drips. Dr Jones: So, it sounds like the definitions have evolved in a way that improves the outcomes, right? To do earlier identification of status epilepticus and more aggressive management, I think that's a great takeaway. If we move all the way to the other end of the spectrum, let's move to the ambulatory setting and we have a patient who comes in and they've had one seizure, they're an adult; one seizure, the first seizure. The key question is, how do we anticipate the risk of future seizures? But walk us through how you talk to that patient, how you evaluate that patient to decide if and when to start anti-seizure medicines. Dr Vossler: Well, it depends a little bit if it's an adult or a child, but the decision making process and the data behind it is pretty robust now. And the decision making process is pretty similar for adults and children, with some differences which I can talk about. First of all, first seizures. I think it's really important to stress that there's been so much research in this area. I'd like to get a cross point that they're not as innocuous as I think many general neurologists might suspect. We know that there is a two- to threefold increased risk of death in children and adults following a first seizure. Moreover, the risk of a second seizure, both in kids and adults, is about 36% two years after that first seizure. It's about 46% five years after that first seizure. It's really pretty substantial. The risk of a second seizure is increased twofold. It doubled in the presence of any kind of a history of prior brain insults that could result in seizures. Could be infections, it could be a prior stroke, it could be prior significant brain trauma. It's also doubled in the presence of an EEG, which shows epileptiform discharges like spikes and sharp waves---and not just a sort of borderline things like sharply contoured rhythmic Theta activity. That's really not what we're talking about. We're talking about overt epileptiform discharges. It's doubled in the presence of lesion that can be seen on imaging studies, and it's doubled in the presence of seizures if that first seizure occurs during sleep. So, we have a number of things that double the risks, above the risk of a second seizure, above that 36% at two years and 46% at five years that I spoke about. And so those things need to be considered when you're counseling a patient about that. Should you be on an anti-seizure medicine after that first seizure? Specifically, to the point of anti-seizure medications, the guideline that was done, the 2015 guideline that was done by the American Academy of Neurology for adults, and the 2003 guideline was actually a practice parameter that was done by the Academy and the American Epilepsy Society for children, are really kind of out of date. They talk about the adverse effects of anti-seizure medications, but when you look back at the studies that were included in developing that practice parameter for kids and guidelines for adults, they are the old drugs: carbamazepine, phenytoin, phenobarbital and valproate. Well, I don't think I need to tell this audience, this well-educated audience, that we don't use those drugs anymore. We are using more modern anti-seizure medicines that have been developed since 1995; things like lamotrigine, levetiracetam, and lecosamide. Those three in particular have very low adverse events. So, the guideline that the Academy, American Academy Neurology and American Epilepsy Society put together for kids and for adults talks about this high adverse event profile. And so, you need to take a look at the risks that I talked about of a seizure recurrence and balance that against adverse effects. But I'm here to tell you that the newer anti-seizure medicines---and by newer I'm talking in the last thirty years since lamotrigine was approved in 1995---these drugs have much better side effect profiles. And I think all epileptologists would agree with that. They're not necessarily more effective, but they are better tolerated. That makes the discussion of the risk of a second seizure, the risk of mortality versus side effects of drugs, it really pushes the risk category higher on the first side and not on the side of drugs. We know that if you take an anti-seizure medicine, you reduce your risk of a second seizure by half. Now, that's not sustained over five years, but over the first two years, you've reduced it by half. In a person who's driving, needs to get to work, has to take the kids to school, whatever, most of my patients are like, yeah, okay, sign me up. These drugs are really pretty well tolerated. There's a substantial risk of a second seizure. So, I'll do that. In a kid,  a child that's, you know, not driving yet, that might be a different discussion. And the parents might say, well, I'd rather not have my son exposed, my daughter exposed to this. They're trying to go to school. They're trying to learn. We don't want to hinder that. We'll wait for a second seizure and then if they have a second seizure, which by the way is, you know, one of the definitions of epilepsy, well then they have epilepsy, then they probably will need to go on the seizure medication. Dr Jones: Great summary, Dr Vossler, and it is worth our audience being aware that the evidence has evolved alongside the improvement in the adverse effect profile. And sounds like your threshold is a little lower to treat then maybe it would have been some time ago, right? Dr Vossler: I would say that's exactly correct in my opinion. Particularly for adults, absolutely. Dr Jones: That's fantastic, Dr Vossler. I imagine there are a lot of aspects of caring for these patients that are challenging, and I imagine many scenarios are actually pretty rewarding. What do you find the most rewarding aspect of caring for patients with acute seizure management? Dr Vossler: Yes, I mean, that is really true. I would say that the most challenging things are treating refractory status epilepticus, but worse yet, new onset refractory status epilepticus and the super refractory status epilepticus, which I talk extensively about or write extensively about in the article and provide a lot of guidance on. Really, those conditions are so challenging because they can go on for such a long time. Patients are hospitalized for a long time. A lot of really good clinical guidance doesn't exist yet. There is a tremendous amount of research in that area which I find exciting, and really there's an amazing amount of international research on that, I think most of our audience probably is unaware of. And certainly, with those conditions, there is a high risk of later disability and mortality. We go through all of that in the article. The rewards really come from helping these people. When someone was super refractory status and it were non- sorry, new onset refractory status epilepticus, has been in the hospital for thirty days, it gets really hard for everybody; the family, the patient. And for us, it wears on us. Yet when they walk out the door, and I've had these people come back to the epilepsy clinic and see me later. We're managing their anti-seizure medications. They've survived. The NORSE patients often have substantial disability. They have cognitive and memory and even some psychiatric disability. But yet we can help them. It's not just management in the hospital, but it's getting to know these people, and I take them from the hospital and see them in my clinic and manage them long-term. I get a lot of great satisfaction out of that. We're hoping to do even better, stop patients' status early and get them to recover with no sequelae. Dr Jones: What a great visual, seeing those patients who have a devastating problem and they come back to clinic and you get the full circle. And what a great place to end. Dr Vossler, thank you so much for joining us, and thank you for such a thorough and fascinating discussion on the importance of understanding and managing patients with the first seizure, acute repetitive seizures, and status epilepticus. Dr Vossler: Thank you very much, Lyell. Dr Jones: Again, we've been speaking with Dr Dave Vossler, author of an article on emergent seizure management, first seizures, acute repetitive seizures and status epilepticus in Continuum's most recent issue on epilepsy. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

N Engl J Med 2013;369:1115-23Background: The COURAGE trial was published in 2007. It compared up-front PCI to medical therapy alone in patients with stable CAD. Preventive PCI did not reduce the chance of dying or having a heart attack over a median follow up time of 5 years. The results rocked the cardiology world because for years prior to the publication of COURAGE, the standard of care called for revascularization of obstructive coronary stenosis. Despite what we would consider minor criticisms of COURAGE, the results have held over time as a preventive PCI strategy has failed repeatedly to reduce death or MI compared to medicine alone in subsequent large trials (BARI 2D, FAME 2, ISCHEMIA and ISCHEMIA-CKD) involving patients with stable CAD. But what about patients with acute coronary syndromes who have, a clearly defined “culprit” lesion and stable coronary stenosis of a non-infarct vessel? On the surface, the answer might seem simple - treat the “culprit” lesion with PCI and leave the stable disease alone. Continue optimal medical treatment of stable CAD indefinitely with consideration of revascularization only if new symptoms arise. But what if a stable coronary stenosis behaves differently in a patient with an acute coronary syndrome than in patients without it? Are these patients predisposed or particularly susceptible to acute plaque rupture and thrombogenesis to such an extent that they would benefit from a preventive revascularization strategy? The Primary Angioplasty in Myocardial Infarction (PRAMI) trial sought to test the hypothesis that immediate preventive PCI of non-culprit vessels plus the culprit vessel compared to culprit vessel only PCI would improve outcomes in patients with a STEMI and coronary stenosis of a non-infarct related artery.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: From 2008 through 2013, patients were enrolled from 5 coronary care centers in the United Kingdom. Patients could be any age with acute STEMI and multivessel CAD detected at the time of emergency PCI. The trial was limited to patients with STEMI because ST-segment elevation, unlike ST-segment depression, localizes the area of ischemia in the myocardium and an “infarct-artery” is usually easy to distinguish. Clinically stable patients were considered for eligibility after undergoing PCI of the infarct artery while they were in the catheterization lab. They were eligible if successful PCI of infarct artery was performed and there was stenosis of 50% or more in one or more non-infarct arteries. Exclusion criteria included cardiogenic shock, previous CABG, had left main or significant disease in the ostia of both the LAD and circumflex vessels, or if the only non-infarct stenosis was a chronic total occlusion.Baseline characteristics: The trial screened 2,428 patients and randomized 465 patients (19%) with 234 to preventive PCI and 231 to no preventive-PCI. The majority of patients were excluded for single vessel disease (1122/1922 [58%]). The average age of patients was 62 years and more than 75% were men. Close to 50% were current smokers. The infarct artery was anterior in 35%, inferior in 60% and lateral in 5%. Approximately 65% of patients had 2 vessel disease and 35% had 3 vessel disease.Procedures: After completion of PCI in the infarct artery, eligible patients were randomized and those assigned to the preventive-PCI group underwent the procedure immediately in all non-infarct arteries with a coronary stenosis >50%. PCI was discouraged at a later date (sometimes this strategy is referred to as “staged PCI”) in the no preventive-PCI group unless it was symptom driven. Any patient in the trial with subsequent symptoms of angina that were not controlled with medicine was required to undergo objective assessment of ischemia to secure a diagnosis of refractory angina. Follow-up information was collected at 6 weeks and then yearly thereafter.Endpoints: The primary endpoint was a composite of death from cardiac causes, nonfatal MI, or refractory angina. Secondary outcomes included the individual components of the composite endpoint along with noncardiac death and repeat revascularization. Myocardial infarction was defined as symptoms of cardiac ischemia and a troponin level >99% URL. However, within 14 days after randomization, MI diagnosis also required ECG evidence of new STE or left bundle branch block and angiographic evidence of coronary artery occlusion (essentially this makes it so only in-stent thrombosis or spontaneous STEMI count and other causes of peri-procedural MI do not - this would bias the trial in favor of the preventive-PCI group).Refractory angina was defined as angina despite medical therapy and objective evidence of myocardial ischemia (i.e., ischemia on ECG during spontaneous episode of pain or abnormal results on functional testing).It was determined that 600 patients would be needed to achieve 80% power to detect a 30% relative reduction in the preventive-PCI group, at a 5% level of significance, assuming an annual rate of the primary outcome of 20% in the control group. Stopping criteria were prespecified if the results from the trial showed a primary outcome difference at the 0.001 level of significance. Results: The trial was stopped early based on a significant difference (P50%, preventive PCI significantly reduced a primary composite outcome of cardiac death, nonfatal MI and refractory angina in the PRAMI trial with an estimated NNT of 7 patients over 2 years. Individual components of the primary endpoint that were significantly reduced included nonfatal MI and refractory angina by similarly large margins. These results may seem impressive at first glance but we urge extreme caution in their interpretation. First, this is a relatively small trial with a historically large effect size, especially when considering hard endpoints like cardiac death and nonfatal MI were included. Such results are often later found to be falsely positive when larger, confirmatory studies are conducted. Second, the trial was stopped early and early stopping is prone to yield false positive and/or exaggerated results. Third, inclusion of refractory angina in the primary endpoint, an endpoint susceptible to bias in an unblinded study (see earlier discussion of “faith healing” and “subtraction anxiety” in FAME 2; consideration also must be given to nocebo effects in patients who know they have “untreated blockages”), clouds the main findings by inflating the effect size and making the trial susceptible to large differences in underpowered endpoints before sufficient data can be accumulated on hard outcomes. For example, if the trial had sought to detect a conservative difference of 30% in a primary composite endpoint that only included cardiac death or nonfatal MI, based on an event rate of 12% in the control group (the actual event rate in the trial), over 2,200 patients would be needed for 80% power at a 5% level of significance. The estimated number of actual events would be around 230. However, only 47 events occurred in PRAMI making the results highly susceptible to noise.While results of PRAMI suggest a beneficial role for preventive-PCI in patients with STEMI, more evidence is needed to confirm the results.Thanks for reading Cardiology Trial's Substack! This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Prof Martin Hutchings from Copenhagen University Hospital in Denmark, Dr Manali Kamdar from the University of Colorado Cancer Center, Dr Matthew Lunning from the University of Nebraska Medical Center and Prof Gilles Salles from Memorial Sloan Kettering Cancer Center in New York summarize currently available data guiding treatment decision-making for patients with relapsed/refractory diffuse large B-cell lymphoma and present cases from their practices.CME information and select publications here.

Featuring slide presentations and related discussion from Prof Martin Hutchings, Dr Manali Kamdar, Dr Matthew Lunning and Prof Gilles Salles, including the following topics: Evolving Role of Chimeric Antigen Receptor (CAR) T-Cell Therapy in Diffuse Large B-Cell Lymphoma (DLBCL) — Dr Kamdar (0:00) Case: A 61-year-old man with Stage IV non-GCB DLBCL receives R-CHOP but experiences disease progression 8 months later (30:39) Case: A 68-year-old man with double-hit DLBCL who experiences disease progression on chemotherapy and second-line CAR T-cell therapy receives glofitamab (39:22) Incorporation of Bispecific Antibody Therapy into DLBCL Management — Prof Hutchings (45:25) Case: A 42-year-old man with progressive DLBCL refractory to 2 lines of therapy receives glofitamab with a durable response (1:07:30) Case: An 81-year-old woman with multiregimen-refractory DLBCL experiences a prolonged response to epcoritamab (1:14:25) Case: A 69-year-old man with follicular lymphoma transformed to DLBCL and refractory to 3 lines of treatment receives glofitamab (1:21:48) Selection and Sequencing of Other Available Therapies for Relapsed/Refractory (R/R) DLBCL — Prof Salles (1:24:37) Case: An 82-year-old woman with follicular lymphoma transformed to DLBCL receives tafasitamab/lenalidomide (1:42:05) Case: A 69-year-old man with urinary bladder carcinoma and recurrent GCB DLBCL receives loncastuximab tesirine (1:46:26) Promising Investigational Approaches for Patients with R/R DLBCL — Dr Lunning (2:00:37) Case: An 80-year-old woman with multiregimen-refractory GCB DLBCL seeks treatment requiring minimal clinic visits and receives loncastuximab tesirine (2:15:59) Case: A 54-year-old man with primary refractory non-GCB DLBCL receives CAR T-cell therapy, and follow-up imaging on day 29 demonstrates a Deauville score of 4 (2:25:22) CME information and select publications

Prof Martin Hutchings from Copenhagen University Hospital in Denmark, Dr Manali Kamdar from the University of Colorado Cancer Center, Dr Matthew Lunning from the University of Nebraska Medical Center and Prof Gilles Salles from Memorial Sloan Kettering Cancer Center in New York summarize currently available data guiding treatment decision-making for patients with relapsed/refractory diffuse large B-cell lymphoma and present cases from their practices.CME information and select publications here.

Sovereign Metals Ltd has confirmed that graphite concentrate from the Kasiya Rutile-Graphite Project in Malawi meets all key requirements for refractory applications. Testing was conducted by German laboratories ProGraphite and Dorfner Anzaplan. Refractories, which are used in high-temperature industrial processes, account for 24% of the natural graphite market, making them the second-largest end-use sector after battery applications, which hold a 52% market share. The refractories market requires large, coarse graphite flakes with specific chemical and physical properties. According to Sovereign Metals, approximately 70% of Kasiya's graphite meets these size requirements. The company states that its latest test results confirm Kasiya's graphite also meets or exceeds the necessary chemical and physical specifications for refractories. These findings, combined with previous positive results for battery anode materials, support the quality of Kasiya's graphite and strengthen the project's sales and marketing potential. In Q4 2024, large flake graphite was priced at up to US$1,193 per tonne, while smaller flake graphite was priced at US$564 per tonne. Kasiya's graphite concentrate is expected to be produced at US$241 per tonne (FOB), potentially allowing for significant margins. #SovereignMetals #KasiyaProject #Graphite #Refractories #IndustrialMaterials #BatteryMaterials #Mining #NaturalGraphite #FlakeGraphite #Manufacturing #HighTemperature #RutileGraphite #GraphiteMarket

Laurence Albiges joins the show to discuss novel combos in refractory RCC and an update of the Ipi/Nivo/Cabo COSMIC OS data

Toni Choueiri discusses the updated data from different cohorts of this novel HIF inhibitor.

CardioNerds (Dr. Colin Blumenthal and Dr. Saahil Jumkhawala) join Dr. Rohan Ganti, Dr. Nikita Mishra, and Dr. Jorge Naranjo from the Rutgers – Robert Wood Johnson program for a college basketball game, as the buzz around campus is high. They discuss the following case involving a patient with ventricular tachycardia:  The case involves a 61-year-old man with a medical history of hypothyroidism, hypertension, hyperlipidemia, seizure disorder on anti-epileptic medications, and major depressive disorder, who presented to the ER following an out-of-hospital cardiac arrest. During hospitalization, he experienced refractory polymorphic ventricular tachycardia (VT), requiring 18 defibrillation shocks. Further evaluation revealed non-obstructive hypertrophic cardiomyopathy (HCM). We review the initial management of electrical storm, special ECG considerations, diagnostic approaches once ischemia has been excluded, medications implicated in polymorphic VT, the role of multi-modality imaging in diagnosing hypertrophic cardiomyopathy, and risk stratification for implantable cardioverter-defibrillator (ICD) placement in patients with HCM.  Expert commentary is provided by Dr. Sabahat Bokhari.   Episode audio was edited by CardioNerds Intern and student Dr. Pacey Wetstein.   US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - A Curious Case of Refractory Ventricular Tachycardia - Rutgers-Robert Wood Johnson Diagnostic Uncertainty in VT Storm: In VT storm, ischemia is a primary consideration; when coronary angiography excludes significant epicardial disease, alternative causes such as cardiomyopathies, channelopathies, myocarditis, electrolyte disturbances, or drug-induced arrhythmias must be explored.  ST elevations in ECG lead aVR:  ST elevations in lead aVR and diffuse ST depressions can sometimes represent post-arrest oxygen demand and myocardial mismatch rather than an acute coronary syndrome. This pattern may occur in the context of polymorphic VT (PMVT), where myocardial oxygen demands outstrip supply, especially after an arrest. While these ECG changes could suggest myocardial ischemia, caution is needed, as they might not always indicate coronary pathology. However, PMVT generally should raise suspicion for underlying coronary disease and may warrant a coronary angiogram for further evaluation.  Medication Implications in PMVT and HCM: Certain medications, including psychotropic drugs (e.g., antidepressants, antipsychotics) and anti-epileptic drugs, can prolong the QT interval or interact with other drugs, thereby increasing the risk of polymorphic VT in patients with underlying conditions like HCM. Careful management of these medications is critical to avoid arrhythmic events in predisposed individuals.  Multi-Modality Imaging in HCM: Cardiac MRI with late gadolinium enhancement (LGE) is invaluable in assessing myocardial fibrosis, a key predictor of arrhythmic risk, and can guide decisions regarding ICD implantation. Echocardiography and contrast-enhanced CT can provide additional insights into structural abnormalities and risk assessment.  Polymorphic VT in Nonobstructive HCM: Polymorphic ventricular tachycardia (PMVT) can occur in nonobstructive hypertrophic cardiomyopathy due to myocardial fibrosis and disarray, even in the absence of significant late gadolinium enhancement and left ventricular outflow tract obstruction.  ICD Risk Stratification in HCM: Risk stratification for ICD placement in HCM includes assessment of clinical features such as family history of sudden cardiac death, history of unexplained syncope, presence of nonsustained VT on ambulatory monitoring,

In this week's episode we'll find out about longer term results from a pivotal trial of mosunetuzumab in relapsed/refractory follicular lymphoma, potential use of CD70 CAR T-cells that secrete an anti-CD33/anti-CD3 bispecific antibody as a therapy for acute myeloid leukemia, and how ferroptosis regulates hemolysis in stored red blood cells.Featured Articles:Long-term 3-year follow-up of mosunetuzumab in relapsed or refractory follicular lymphoma after ≥2 prior therapiesCD70 CAR T cells secreting an anti-CD33/anti-CD3 dual-targeting antibody overcome antigen heterogeneity in AMLFerroptosis regulates hemolysis in stored murine and human red blood cells

This week, we talk all about disseminated testicular cancer, highlighting our current treatment modalities and why we do what we do. We also cover refractory disease. This episode builds on our prior discussions in Parts 1 and 2, so be sure to check these out if you haven't already!Episode contents:- A history lesson about how we developed our current risk stratification model - Our current treatment paradigms and regimens for disseminated seminoma and non-seminoma - To resect or not to resect? - How we approach relapsed/refractory disease ****Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

In this episode, Shaji K. Kumar, MD, reviews key data on bispecific antibodies used to treat patients with relapsed/refractory multiple myeloma recently presented at the 2024 annual American Society of Hematology meeting, including:Early results with teclistamab combined with anti-CD38 therapyReal-world data with teclistamab including its use after other BCMA-targeted therapiesTalquetamab as bridging therapy to BCMA-targeted CAR T-cell therapyEvaluation of prophylactic tocilizumab for cytokine-release syndrome associated with bispecific antibody therapyPresenter:Shaji K. Kumar, MDMark and Judy Mullins Professor of Hematologic MalignanciesConsultant, Division of HematologyProfessor of MedicineChair, Myeloma, Amyloidosis and Dysproteinemia GroupResearch Chair, Division of HematologyAssociate Chair for Research, Department of MedicineMayo ClinicRochester, MinnesotaLink to full program:https://bit.ly/40bjFCZ

Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.Chapters: • Defining refractory cardiac arrest • Antiarrhythmic drugs: amiodarone vs. lidocaine • Defibrillation strategies: vector change and double sequential defibrillation • Emerging therapies: stellate ganglion blocks and electrical storm management • ECPR: who qualifies and what the trials say • Equity and feasibility challenges in cardiac arrest management • ICU recovery clinics and patient-centered outcomes • Clinical trials: barriers to enrollment and the need for changeReferences: 1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1] 2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736 3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396 4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112 Disclaimer:This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.

Editor in Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Lee M. Akst, MD, and Associate Editor Christopher M. Johnson, MD, to discuss diagnosis of, treatments, and solutions for refractory chronic cough as outlined in the paper “Refractory Chronic Cough: A State-of-the-Art Review for Otolaryngologists” which published in the February 2025 issue of Otolaryngology–Head and Neck Surgery. They discuss both the paper's findings and their own experiences caring for patients with this condition.  Click here to read the full article.

Show notes at pharmacyjoe.com/episode997. The post 997: The use of methylene blue for the treatment of refractory anaphylaxis without hypotension appeared first on Pharmacy Joe.

In this week's episode we'll learn more about a phase 2 trial of first-line zanubrutinib, obinutuzumab, and venetoclax in TP53-mutated mantle cell lymphoma; early development of hyperdiploidy in multiple myeloma; and a phase 1 trial of the asparaginase pegcrisantaspase plus venetoclax in relapsed/refractory acute myeloid leukemia.Featured Articles:Zanubrutinib, obinutuzumab, and venetoclax for first-line treatment of mantle cell lymphoma with a TP53 mutationDevelopment of hyperdiploidy starts at an early age and takes a decade to completeA phase 1 study of the amino acid modulator pegcrisantaspase and venetoclax for relapsed or refractory acute myeloid leukemia

In this podcast, we explore the latest advancements in the treatment of PD-1 refractory melanoma. This week, we are joined... The post Therapeutic options for PD1 refractory skin cancer appeared first on VJOncology.

Welcome to our first episode in a series on Cardiac Intensive Care, recorded live at the Critical Care Canada Forum 2024. We kick off by looking at the latest Clinical Practice Update on post cardiac arrest care and refractory cardiac arrest. The "Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care" CCS was published in 2024, and provides comprehensive recommendations for the management of patients following cardiac arrest. Join us as Dr Janek Senaratne unpacks this Clinical Practice Update (CPU), and guides us through the evidence for the recommendations made. Dr. Janek Senaratne is a dual-trained cardiologist and intensivist based in Edmonton, Alberta. He serves as an Associate Clinical Professor in the Department of Medicine at the University of Alberta. University of Alberta In his clinical roles, Dr. Senaratne practices at the University of Alberta Hospital and Grey Nuns Hospital, and is one of the Vital Heart Response physicians for the province. Further Reading:

Listen to a soundcast of the 12.18.2024 FDA approval of Ryoncil (remestemcel-L-rknd) for steroid-refractory acute graft versus host disease in pediatric patients.

Host Dr. Nick Athanasiou is joined by Dr. David Fiellin and Dr. Eric Strain to discuss the concept of Treatment Refractory Addiction.  Why does the field of addiction medicine need this term, how is it defined and how the current treatment system aligns with the idea? Listen to the full interview to learn more!   Treatment Failure Versus Failed Treatments: The Risks of Embracing Treatment Refractory Addiction [Dr. David Fiellin] The Concept of Treatment-Refractory Addiction: A Call to the Field [Dr. Eric Strain] The Concept of Treatment-Refractory Addiction: Implications for Addiction Treatment Systems and Research [Dr. Edward Nunes & Dr. Thomas McLellan] - Subscribe to the ASAM Weekly

Wanna collapse the timelines to your success? Mouthy bartender turned mouthy millionaire in her first year, Nicole Cherie Hesse has lots of unpopular unicorn opinions to share…Anything but conventional, Nicole paved a path to seven figures using existing skills from her colorful life as a kick-ass bartender. By repositioning what she already knew into the online coaching industry, she catapulted to the 1% overnight.This podcast details the adventures she's had along the way and is sprinkled with helpful AF unicorn hacks to help you to follow in her unicorn hoof prints.Whether you are a bartender who wants to unlock another revenue stream or an experienced entrepreneur looking to scale to six figure months, Nicole will f*ck you up in all of the best ways. Take off your pants and get your ass to the podcast this and every week to level up and crush your unicorn goals. Join her FB group to fully immerse yourself in Wonder World, your future self will thank you... For even more money-making strategies, hop on over to the Facebook group! Ready to attract unicorn clients!? Book a call with the Wonder Team!And as always, for more trouble go to Real Unicorns Don't Wear Pants!

This week, we round out our AML series with a detailed discussion about the approach to management of relapsed and refractory disease. This has been a VERY long road going through all management of AML. We hope that you have continued to build on our discussions week-to-week. An exciting treatment paradigm that is ever-evolving! Episode contents: - How do we define primary induction failure in AML? - What are options for treatment of refractory disease? What is the mechanism of action of these treatment options? - What are options for relapsed disease? - What targeted therapies are available for relapsed AML? ****This episode is sponsored by our global research partners! Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Please visit answersincme.com/GPV860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in oncology discusses bispecific antibodies in the current treatment landscape of relapsed/refractory multiple myeloma. Upon completion of this activity, participants should be better able to: Review the role of bispecific antibodies in the current treatment landscape of relapsed/refractory (R/R) multiple myeloma (MM); Discuss the clinical profiles of approved and late-stage emerging bispecific antibodies in heavily pretreated R/R MM; and Describe strategies to optimize outcomes with bispecific antibodies for the treatment of R/R MM. This activity is intended for US healthcare professionals only.

Dr Alexander Perl from Abramson Cancer Center in Philadelphia, Pennsylvania, Dr Richard M Stone from Dana-Farber Cancer Institute in Boston, Massachusetts, Dr Eunice S Wang from Roswell Park Comprehensive Cancer Center in Buffalo, New York, Prof Andrew H Wei from Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, and moderator Dr Eytan M Stein from Memorial Sloan Kettering Cancer Center in New York, New York, discuss updated data from ASH 2024 influencing the current and future treatment paradigm for treatment-naïve and relapsed/refractory acute myeloid leukemia. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/ASHAML24).

Dirk Arnold, MD, PhD - Still in the Game! Optimising Treatment Sequencing in the Management of Relapsed or Refractory mCRC

Dirk Arnold, MD, PhD - Still in the Game! Optimising Treatment Sequencing in the Management of Relapsed or Refractory mCRC

Dirk Arnold, MD, PhD - Still in the Game! Optimising Treatment Sequencing in the Management of Relapsed or Refractory mCRC

In this week's episode, we'll be comparing BTK inhibitors in relapsed/refractory CLL. Then, we'll hear how researchers in the UK unraveled the genetic background of the AnWj blood group.  Finally we'll learn about the role of BCL-2 and BAFF in CLL cell survival following venetoclax therapy. Featured Articles:Deletions in the MAL gene result in loss of Mal protein, defining the rare inherited AnWj-negative blood group phenotypeSustained benefit of zanubrutinib vs ibrutinib in patients with R/R CLL/SLL: final comparative analysis of ALPINEVenetoclax dose escalation rapidly activates a BAFF/BCL-2 survival axis in chronic lymphocytic leukemia

Discover key updates on emerging immunotherapy combinations in relapsed/refractory (R/R) follicular lymphoma (FL) from the hematology congress in San Diego. Credit available for this activity expires: 12/18/25 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1002061?ecd=bdc_podcast_libsyn_mscpedu

Join Michael Lloyd and his guests Wendy Tzou, and Jason Jacobson as they discuss this late breaker in person at APHRS 2024 in Sydney, Australia. https://www.hrsonline.org/education/TheLead https://pubmed.ncbi.nlm.nih.gov/39331050/ Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Membership on Advisory Committees: Boston Scientific   Contributor Disclosure(s): J. Jacobson: Honoraria/Speaking/Teaching/Consulting: Zoll Medical, Vektor Medical, Inc., Abbott Medical, Research (Contracted Grants): CardioFocus, Inc., Stocks, Privately Held: Atlas 5D W. Tzou: Research (Contracted Grants): Abbott Medical, Membership on Advisory Committees: Medtronic, Inc., Biosense Webster, Inc., Kardium, BioTelemetry, Inc., Honoraria/Speaking/Teaching/Consulting: Biotronik, Mediasphere Medical, American Heart Association, Medtronic, Abbott, Biosense Webster, Inc., Boston Scientific

In this episode, Lillian Erdahl, MD, FACS, is joined by Fatemeh Shojaeian, MD, MPH, from the Johns Hopkins University School of Medicine. They discuss Dr Shojaeian's recent article, “Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial,” in which the authors found that, for resistant or relapsing patients with idiopathic granulomatous mastitis, combining methotrexate and corticosteroids offers a promising strategy. This integration of disease-modifying antirheumatic drugs with corticosteroids not only reduces the necessity for high steroid doses but also effectively alleviates associated side effects.   Disclosure Information: Drs Erdahl and Shojaeian have nothing to disclose.   To earn 0.25 AMA PRA Category 1 Credits™ for this episode of the JACS Operative Word Podcast, click here to register for the course and complete the evaluation. Listeners can earn CME credit for this podcast for up to 2 years after the original air date.   Learn more about the Journal of the American College of Surgeons, a monthly peer-reviewed journal publishing original contributions on all aspects of surgery, including scientific articles, collective reviews, experimental investigations, and more.   #JACSOperativeWord

In this week's episode we'll learn more about how clonal hematopoiesis affects prognosis in patients with telomere biology disorders, consider recently uncovered molecular subtypes of extracutaneous juvenile xanthogranulomas, and discuss a clinical trial of the BCMA-CD3 bispecific antibody teclistamab in patients with relapsed/refractory multiple myeloma who have received previous BCMA-targeted therapy.Featured Articles:Clonal landscape and clinical outcomes of telomere biology disorders: somatic rescue and cancer mutationsRecurrent CLTC::SYK fusions and CSF1R mutations in juvenile xanthogranuloma of soft tissueEfficacy and safety of teclistamab in patients with relapsed/refractory multiple myeloma after BCMA-targeting therapies

In this week's episode we'll learn more about a new risk classification scheme for use in patients with acute myeloid leukemia who are ineligible for intensive therapy, efficacy and safety of daratumumab plus chemotherapy in pediatric patients with acute lymphoblastic leukemia or lymphoblastic lymphoma, and a blood bank-compatible method for creating genetically engineered platelets with a wide range of potential uses.Featured Articles:Genetic Risk Stratification and Outcomes Among Treatment-Naive Patients with AML Treated With Venetoclax and Azacitidine Daratumumab in Pediatric Relapsed/Refractory Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma: DELPHINUS Study Genetic Engineering of Transfusable Platelets with mRNA-Lipid Nanoparticles is Compatible with Blood Banking Practices  

The refractory period is the period after orgasm when your arousal drops, and you are unable to acquire or maintain an erection. While different people have different refractory periods, there's actually a lot you can do to shorten yours!So, if you want to start round 2 as quickly as possible, the tips in this episode will show you how.---Website: https://lewdlexi.comSign up for my email newsletter! https://lewdlexi.com/email/Patreon: https://patreon.com/lewdlexiaudioBook a call with me: https://lewdlexi.com/phoneOther links: https://linktr.ee/lewdlexiaudio

In this episode, I am joined by Nicholas Silvestri, Professor of Neurology at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, where he is also Associate Dean for Student and Academic Affairs. He is board-certified in neurology, neuromuscular medicine, and electrodiagnostic medicine.Over the past several years, Nicholas Silvestri's research interests have included myasthenia gravis and inflammatory neuropathies, and he has authored over 60 peer-reviewed articles, book chapters, and textbooks.Our conversation covers the full spectrum of myasthenia gravis – from its pathology and pathogenesis to its clinical features, investigations and treatments. He explains such tricky areas of myasthenia gravis, such as why the antibody levels do not correlate with clinical severity of the disease, and why the disease frequently starts in the ocular muscles.We also explored such themes as why anti MUSK myasthenia gravis favours Black people and those living around the equator, and why steroid treatment may worsen myasthenic symptoms.Nicholas Silvestri also discussed the newer and more effective treatments of refractory myasthenia gravis, and how he manages the different facets of the disease.

When traditional treatments for depression fail, where do we turn? It's easy to feel hopeless when depression impacts your life, or the life of someone you love. Fear not. This is the episode for you.In this episode of Sick Health with Kevin Ban, MD, we dive deep into one of the most promising frontiers in mental health treatment. Joined by Dr. Ben Yudkoff, Chief Medical Officer at Lumen Health and Medical Director of Interventional Psychiatry at Brigham and Women's Faulkner Hospital, we explore the fascinating world of ketamine therapy.Known primarily as an anesthetic, ketamine is emerging as a groundbreaking treatment for depression - but how does it work, are there risks, who is it really for, and what exactly is the difference between it and esketamine? From the molecular level to real patient experiences, we unpack the science and stories behind this transformative therapy.Starting with the basics, Dr. Yudkoff guides us through the remarkable journey of how ketamine went from the operating room to mental health breakthrough. We explore the intricate brain chemistry that makes this treatment unique, and how it helps create new neural pathways for those stuck in persistent negative thought patterns.We then tackle the practical aspects - from treatment protocols to insurance coverage, and the critical importance of proper clinical settings. Finally, we address the elephant in the room: the fears and misconceptions about "bad trips" and what really happens during treatment.There's no need to be misinformed anymore. After this episode, you'll understand:Three NON-CHEMICAL treatments for depression you can considerHow ketamine offers new hope for treatment-resistant depressionThe fascinating way ketamine helps rewire negative thought patternsWhy controlled clinical settings are crucial for safe and effective treatmentNavigate insurance coverage and access to ketamine therapyUnderstanding what to expect from treatment and maintenance plansOur conversation isn't just about medication - it's about hope, science, and the future of mental health treatment. Whether you're struggling with depression, know someone who is, or are simply curious about breakthrough treatments in psychiatry, this episode offers valuable perspective on one of today's most promising therapeutic options.As Dr. Yudkoff shares, "As a provider who has lookedFollow us on YouTube and leave your comments at: https://www.youtube.com/@SickHealthwithKevinBanMD Connect with Kevin on Facebook: https://www.facebook.com/profile.php?id=61558197731269 Instagram: https://www.instagram.com/sickhealthigsh=MXQ5Y3Q1ZjE0bnZmdQ%3D%3D Threads: https://www.threads.net/@sickhealth Linkedin: https://www.linkedin.com/company/sick-health-with-kevin-ban-md/ Tik Tok: https://shorturl.at/oORXY Contact email: team@sickhealthshow.com Executive Producer: Kevin Ban, MD Production Director, Editor and Producer: Bat-Sheva Guez Graphic designer: Leah VanWhy YouTube SEO: Lighthouse-Digitalmarketing.com Social media: Rebekah Pajak Intern: Nicole Berritto This show's content represents the personal opinions of Kevin Ban, MD. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not create a physician-patient relationship with Kevin Ban, MD. Always seek the advice of your physician or other health car...

In this episode, Caitlin Costello, MD, discusses important topics related to relapsed/refractory (R/R) multiple myeloma (MM), including:3 bispecific antibodies approved for the treatment of R/R MM that target BCMA or GPRC5DThe role of bispecific antibodies in R/R MMSafety considerations for patients while receiving a bispecific antibodyEmerging data and clinical trials with bispecific antibodiesKey clinical pearls for optimal use of bispecific antibodiesPresenter:Caitlin Costello, MDClinical Professor of MedicineDirector, Multiple Myeloma ProgramDivision of Blood and Marrow TransplantationMoores Cancer CenterUC San DiegoLa Jolla, CaliforniaLink to full program: https://bit.ly/40bjFCZ

In today's episode, supported by Citius Pharmaceuticals, we had the pleasure of speaking with Francine Foss, MD, to discuss the FDA approval of denileukin diftitox-cxdl (Lymphir) for the treatment of patients with relapsed/refractory cutaneous T-cell lymphoma (CTCL) who have received 1 or more prior systemic therapies. Dr Foss is a professor of medicine (hematology) and dermatology and the director of the Multidisciplinary T Cell Lymphoma Program at the Yale School of Medicine, as well as the scientific leader of Lymphoma CRT at Yale Cancer Center in New Haven, Connecticut.  On August 8, 2024, the FDA approved denileukin diftitox for the treatment of patients with relapsed/refractory CTCL who have received at least 1 prior systemic therapy. This regulatory decision was supported by findings from the phase 3 Study 302 (NCT01871727), in which patients who received the agent (n = 69) achieved an objective response rate of 36.2% (95% CI, 25.0%-48.7%) per independent review committee assessment, including a complete response rate of 8.7%. In our exclusive interview, Dr Foss discussed the significance of this approval, key efficacy and safety data from Study 302, and her excitement about reintroducing an agent to the CTCL treatment paradigm that can induce particularly robust responses.

Let's bust the myths around the refractory period that self-limit so many of our erotic experiences. Join us for this myth-busting episode where we cover the basics and beyond of the refractory period and all the myths about it that get in our way. Learn how: Ejaculation and Orgasm are NOT the same physiological event, […]

Bispecific antibodies represent a much-needed option for diverse patients with relapsed/refractory multiple myeloma (RRMM). This podcast activity will highlight key clinical trial evidence leading to approval of bispecific antibodies and will provide guidance on safely incorporating these agents into RRMM treatment paradigms. Clinical case scenarios will also be discussed to optimize and sequence bispecific antibodies to enable improved outcomes among distinct patient subsets.Launch Date: October 3 2024Release Date: October 3, 2024Expiration Date: September 30, 2025FACULTYJoseph Mikhael, MD, MEd, FRCPC, FACPProfessor, Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute (TGen), City of Hope Cancer CenterChief Medical Officer, International Myeloma FoundationConsultant Hematologist and Director, Myeloma Research, Phase 1 Program, HonorHealth Research InstituteAdjunct Professor, College of Health Solutions, Arizona State UniversityCaitlin Costello, MDClinical Professor of MedicineDirector, Multiple Myeloma ProgramDivision of Blood and Marrow TransplantationMoores Cancer CenterUC San DiegoThis podcast provides accredited continuing education credits.  To receive your credit, please read the accreditation information provided at this link below prior to listening to this podcast.https://www.practicepointcme.com/CMEHome/relapsedrefractory-multiple-myeloma-podcast-series-clinical-viewpoints-to-individualize-bispecific-antibody-therapy

Staying abreast of recent clinical practice guidelines for the management of relapsed/refractory mantle cell lymphoma can be challenging for providers who may seldom encounter it in community practice. In this episode, CANCER BUZZ speaks with Jeff Sharman, MD, medical director of hematology research, US Oncology, and director of research, Willamette Valley Cancer Institute, about the role of biomarker testing in guiding treatment decisions and how evidence-based management of treatment-related adverse events can serve this patient population. “Fortunately, treatments such as BTK inhibitors are generally very well tolerated by patients, and there are very few patients who can't take a BTK inhibitor. But as you go up the scale of increasing intensity, such as CAR T-cell, or even allogeneic stem cell transplantation, those are therapies not suitable for patients with more extensive comorbidities.” – Dr. Jeff Sharman, MD   “A collaborative relationship between a community practice and an academic center can be of considerable benefit to a patient, so that as treatment decisions are made, both the physician and patient can feel like they're offering the patient the very best therapy.” – Dr. Jeff Sharman, MD    Jeff Sharman, MD  Medical Director of Hematology Research, US Oncology Director of Research Willamette Valley Cancer Institute Eugene, Oregon    This project is made possible by funding and support provided by Eli Lilly and in collaboration with The Leukemia & Lymphoma Society. Resources Treatment for Relapsed/Refractory Mantle Cell Lymphoma Tip Sheet - ACCC  Relapsed/Refractory Mantle Cell Lymphoma Educational Video Series: Update on New Therapies: https://vimeo.com/942756449 BTK Inhibitors in MCL: https://vimeo.com/942755401 R/R MCL Case Studies: https://vimeo.com/942754652 BTK Inhibitors Stretch Frontline Approaches in Mantle Cell Lymphoma – Targeted Oncology  Emerging Data Continue to Affect BTK Inhibitor Usage in Mantle Cell Lymphoma - OncLive  HCP Fact Sheet: Facts About CAR T-cell Therapy The CAR T-cell Therapy Process Patient-Caregiver CAR T-cell Therapy Facts Learn About CAR T-cell Therapy Mantle Cell Lymphoma Facts for Patients and Caregivers -The Leukemia & Lymphoma Society

Bispecific antibodies represent a much-needed option for diverse patients with relapsed/refractory multiple myeloma (RRMM). This podcast activity will highlight key clinical trial evidence leading to approval of bispecific antibodies and will provide guidance on safely incorporating these agents into RRMM treatment paradigms. Clinical case scenarios will also be discussed to optimize and sequence bispecific antibodies to enable improved outcomes among distinct patient subsets.Launch Date: October 1, 2024Release Date: October 1, 2024Expiration Date: September 30, 2025FACULTYJoseph Mikhael, MD, MEd, FRCPC, FACPProfessor, Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute (TGen), City of Hope Cancer CenterChief Medical Officer, International Myeloma FoundationConsultant Hematologist and Director, Myeloma Research, Phase 1 Program, HonorHealth Research InstituteAdjunct Professor, College of Health Solutions, Arizona State UniversityCaitlin Costello, MDClinical Professor of MedicineDirector, Multiple Myeloma ProgramDivision of Blood and Marrow TransplantationMoores Cancer CenterUC San DiegoThis podcast provides accredited continuing education credits.  To receive your credit, please read the accreditation information provided at this link below prior to listening to this podcast.https://www.practicepointcme.com/CMEHome/relapsedrefractory-multiple-myeloma-podcast-series-clinical-viewpoints-to-individualize-bispecific-antibody-therapy

Dr. Chris Heery is Chief Medical Officer at Arcellx, a company focusing on developing anito-cel, a significant advancement in CAR-T cell therapy, to treat relapsed and refractory multiple myeloma (rrMM). Multiple myeloma is a rare type of blood cancer that affects plasma cells in the bone marrow and has few treatment options. Arcellx is showing promising data from clinical trials with patients with rrMM who have failed prior therapies and have received Fast Track, Orphan Drug, and Regenerative Medicine Advanced Therapy Designations from the FDA for anito-cel. Chris explains, "The company was founded based on an idea that you could take a novel protein structure and modify it to be able to bind to targets on the surface of cancer cells. And over many years of work, the founders were able to demonstrate that that was possible. Over the last three or four years, Arcellx has focused more on taking what were some of those early ideas and turning them into a product that can help patients. For these last three or four years, most of our focus has been around the lead asset that we call anito-cel that treats multiple myeloma and trying to get that product through the approval process to be able to be a commercial product that can be used for patients both in the United States and the rest of the world." "When a patient is diagnosed with multiple myeloma, in general, most patients are older. The median age of diagnosis of multiple myeloma is around 70 years old, and those plasma cells can cause damage to the normal bone marrow by crowding out the normal bone marrow."  "They can also make a lot of the protein that a normal plasma cell would make. By making a lot of that protein, those proteins can cause deposition and damage into other tissues. So, patients can arrive at the clinic with a variety of different symptoms that have to do with either decreased bone marrow activity, decreased number of normal cell populations in their blood, or damage to things like their kidneys or other end organs that you need for normal human function." #Arcellx #CellTherapy #CARTTherapy #RRMM #MultipleMyeloma #BloodCancer #Cancer #RareDisease arcellx.com Download the transcript here

The range of frontline therapy options for mantle cell lymphoma can influence subsequent treatment choices for patients with relapsed or refractory disease. Providers must determine initial treatment based on individual patient characteristics, while also factoring in future treatment options. In this episode, CANCER BUZZ speaks with Nirav Shah, MD, MSHP, associate professor of medicine at Medical College of Wisconsin and Kirollos Hanna, PharmD, BCOP, PCOP, FACCC, assistant professor of pharmacy at Mayo Clinic and director of pharmacy at Minnesota Oncology, about shared decision making in the management of relapsed or refractory mantle cell lymphoma.  “The key to all of this is good collaboration between the community and their affiliates… their partners and academics, or tertiary referral centers, to really engage… these patients in a collaborative format… it really takes a team, a village, to take care of complex mantle cell lymphoma patients. “ –Dr. Nirav Shah, MD, MSHP   “We're not really seeing a lot of CAR T-cell therapy move in the frontline setting just yet, while there are a lot of ongoing clinical trials… Really, right now, it's going to be the patient characteristic: how well they did on frontline therapy, access to care, affordability, institutional preparedness… that would potentially… allow your patient to receive CAR T-cell therapy.” –Kirollos Hanna, PharmD, BCPS, PCOP, FACCC Nirav Shah, MD, MSHP  Associate Professor of Medicine  Medical College of Wisconsin  Division of Hematology and Oncology  Milwaukee, Wisconsin    Kirollos Hanna, PharmD, BCPS, PCOP, FACCC  Assistant Professor of Pharmacy, Mayo Clinic  Director of Pharmacy  Minnesota Oncology   St. Paul, Minnesota    This project is made possible by funding and support provided by Eli Lilly and in collaboration with The Leukemia & Lymphoma Society. Resources Treatment for Relapsed/Refractory Mantle Cell Lymphoma Tip Sheet - ACCC  Relapsed/Refractory Mantle Cell Lymphoma Educational Video Series: Update on New Therapies: https://vimeo.com/942756449 BTK Inhibitors in MCL: https://vimeo.com/942755401 R/R MCL Case Studies: https://vimeo.com/942754652 BTK Inhibitors Stretch Frontline Approaches in Mantle Cell Lymphoma – Targeted Oncology  Emerging Data Continue to Affect BTK Inhibitor Usage in Mantle Cell Lymphoma - OncLive  HCP Fact Sheet: Facts About CAR T-cell Therapy - https://www.lls.org/sites/default/files/2023-10/FSHP1_CART_Factsheet_June2022_rev.pdf   The CAR T-cell Therapy Process - https://www.lls.org/sites/default/files/2024-03/PS100_CART-CellTherapyProcessFlyer_0224.pdf   Patient-Caregiver CAR T-cell Therapy Facts - https://www.lls.org/sites/default/files/2024-04/FS27_CART_Fact_Sheet_0424_rev.pdf   Learn About CAR T-cell Therapy - https://www.lls.org/sites/default/files/2024-03/PS126_CART_ResourceCard_3_24.pdf    Mantle Cell Lymphoma Facts for Patients and Caregivers -The Leukemia & Lymphoma Society  https://lls.org/sites/default/files/2023-08/FS4_Mantle_Cell_Facts_0423rev.pdf   

The range of frontline therapy options for mantle cell lymphoma can influence subsequent treatment choices for patients with relapsed or refractory disease. Providers must determine initial treatment based on individual patient characteristics, while also factoring in future treatment options. In this episode, CANCER BUZZ speaks with Nirav Shah, MD, MSHP, associate professor of medicine at Medical College of Wisconsin and Kirollos Hanna, PharmD, BCOP, PCOP, FACCC, assistant professor of pharmacy at Mayo Clinic and director of pharmacy at Minnesota Oncology, about shared decision making in the management of relapsed or refractory mantle cell lymphoma. “The key to all of this is good collaboration between the community and their affiliates… their partners and academics, or tertiary referral centers, to really engage… these patients in a collaborative format… it really takes a team, a village, to take care of complex mantle cell lymphoma patients. “ –Dr. Nirav Shah, MD, MSHP   “We're not really seeing a lot of CAR T-cell therapy move in the frontline setting just yet, while there are a lot of ongoing clinical trials… Really, right now, it's going to be the patient characteristic: how well they did on frontline therapy, access to care, affordability, institutional preparedness… that would potentially… allow your patient to receive CAR T-cell therapy.” –Kirollos Hanna, PharmD, BCPS, PCOP, FACCC     Nirav Shah, MD, MSHP  Associate Professor of Medicine  Medical College of Wisconsin  Division of Hematology and Oncology  Milwaukee, Wisconsin    Kirollos Hanna, PharmD, BCPS, PCOP, FACCC  Assistant Professor of Pharmacy, Mayo Clinic  Director of Pharmacy  Minnesota Oncology   St. Paul, Minnesota    This project is made possible by funding and support provided by Eli Lilly and in collaboration with The Leukemia & Lymphoma Society. Resources Treatment for Relapsed/Refractory Mantle Cell Lymphoma Tip Sheet - ACCC  Relapsed/Refractory Mantle Cell Lymphoma Educational Video Series: Update on New Therapies: https://vimeo.com/942756449 BTK Inhibitors in MCL: https://vimeo.com/942755401 R/R MCL Case Studies: https://vimeo.com/942754652 BTK Inhibitors Stretch Frontline Approaches in Mantle Cell Lymphoma – Targeted Oncology  Emerging Data Continue to Affect BTK Inhibitor Usage in Mantle Cell Lymphoma - OncLive  HCP Fact Sheet: Facts About CAR T-cell Therapy - https://www.lls.org/sites/default/files/2023-10/FSHP1_CART_Factsheet_June2022_rev.pdf   The CAR T-cell Therapy Process - https://www.lls.org/sites/default/files/2024-03/PS100_CART-CellTherapyProcessFlyer_0224.pdf   Patient-Caregiver CAR T-cell Therapy Facts - https://www.lls.org/sites/default/files/2024-04/FS27_CART_Fact_Sheet_0424_rev.pdf   Learn About CAR T-cell Therapy - https://www.lls.org/sites/default/files/2024-03/PS126_CART_ResourceCard_3_24.pdf    Mantle Cell Lymphoma Facts for Patients and Caregivers -The Leukemia & Lymphoma Society  https://lls.org/sites/default/files/2023-08/FS4_Mantle_Cell_Facts_0423rev.pdf         

Welcome to OncLive On Air®! I'm your host today, Ashling Wahner.  OncLive On Air  is a podcast from OncLive®, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, OncLive covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.  In today's episode, supported by AbbVie, we had the pleasure of speaking with Jennifer Crombie, MD, about the FDA approval of epcoritamab-bysp (Epkinly) for patients with relapsed/refractory follicular lymphoma. Dr Crombie is a physician at Dana-Farber Cancer Institute and an assistant professor of medicine at Harvard Medical School in Boston, Massachusetts. On June 26, 2024, the FDA granted accelerated approval to epcoritamab for the treatment of adult patients with relapsed/refractory follicular lymphoma who have received at least 2 prior lines of systemic therapy. This regulatory decision was supported by findings form the phase 1/2 EPCORE NHL-1 trial (NCT03625037), in which the agent yielded an overall response rate of 82% (95% CI, 74.1%-88.2%) in the primary efficacy cohort (n = 127), including a complete response rate of 60% (95% CI, 50.8%-68.4%).  In our exclusive interview, Dr Crombie discussed the significance of this approval, key findings from the pivotal EPCORE NHL-1 trial, and where the future of the FL treatment paradigm is headed.  ___ That's all we have for today! Thank you for listening to this episode of OncLive On Air, supported by AbbVie. Check back on Mondays and Thursdays for exclusive interviews with leading experts in the oncology field.  For more updates in oncology, be sure to visit www.OncLive.com and sign up for our e-newsletters.  OncLive is also on social media. On X, follow us at @OncLive. On Facebook, like us at OncLive, and follow our OncLive page on LinkedIn.  If you liked today's episode of OncLive On Air, please consider subscribing to our podcast on Apple Podcasts, Spotify, Amazon Music, and many of your other favorite podcast platforms,* so you get a notification every time a new episode is posted. While you are there, please take a moment to rate us!  Thanks again for listening to OncLive On Air.  *OncLive On Air is available on: Apple Podcasts, Google Podcasts, Spotify, Amazon Music, Audacy, CastBox, Deezer, iHeart, JioSaavn, Listen Notes, Player FM, Podcast Addict, Podchaser, RadioPublic, and TuneIn. 

Status Epilepticus: Part II Special Guest: Jason Vilar, PharmD, BCCCP @TheBrainPharmD   03:40 – Definitions/Terminology 14:30 – Landmark status epilepticus (SE) literature 21:30 – Emergent ASM SE pharmacotherapy 26:00 – DDI management/TDM 33:55 – Refractory status epilepticus (RSE) treatment 48:15 – Medication safety considerations and weaning 58:00 – EEGs for PharmD's 68:10 – Inhaled anesthetics 74:30 – Studies on the horizon/take-home points   Reference List: https://pharmacytodose.com/wp-content/uploads/2024/08/status-epilepticus-part-ii-references.pdf   PharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Send us a Text Message.Vasopressin as adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension in term newborns.Santelices F, Masoli D, Kattan J, Toso A, Luco M.J Perinatol. 2024 Jul 4. doi: 10.1038/s41372-024-02015-0. Online ahead of print.PMID: 38965377 As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!