Explore "nitric" with insightful episodes like "NITRIC Trial - Panel Discussion", "NITRIC Trial - Viewer's Questions", "NITRIC Trial Editorial", "NITRIC Trial Results" and "207: Partnerships to Advance Public Health" from podcasts like ""Critical Care Reviews Podcast", "Critical Care Reviews Podcast", "Critical Care Reviews Podcast", "Critical Care Reviews Podcast" and "This Week in Microbiology"" and more!
Rob Mac Sweeney (Belfast, Northern Ireland) hosts a panel discussion including Prof Paul Checchia (Houston, USA), Prof Wes Diddle (Washington DC, USA), Prof Ranjit Lall (Coventry, England), Prof Kathy Rowan (London, England), as well as the NITRIC trial chief investigator Luregn Schlapbach (Zurich, Switzerland) and editorialist Prof Mark Peters (London, England)
Dr Bronwen Connolly asks cheif investigator Luregn Schlapbach questions from the viewers during the livestream of the NITRIC trial results
Prof Mark Peters, from Great Ormond Street Hospital, delivers an editorial on the NITRIC trial, investigating nitric oxide during cardiac surgery for children with congenital cardiac disease. The chief investigator for the trial Assoc Prof Luregn Schlapbach replies.
Assoc Prof Luregn Schlapbach (Zurich, Switzerland) presents the results of the NITRIC trial, investigating nitric oxide during cardiac surgery for children with congenital cardiac disease.
From ASM Microbe 2019 in San Francisco, Vincent speaks with Victoria McGovern, Carl Nathan, and Dan Portnoy about advancing human health through innovative collaborations.
Host: Vincent Racaniello
Guests: Victoria McGovern, Carl Nathan, and Dan Portnoy
Links for this episode:
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Music used on TWiM is composed and performed by Ronald Jenkees and used with permission.
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Does your penis actually shrink with age? The answer may surprise you. Listen to this episode and you'll find out why it's not the end of the world, plus several simple lifestyle changes you can make to help with the problem.
“Man should no more breathe through his mouth as he would attempt to take food in through his nose”. Yogi Ramacharaka.
In contrast to the disastrous western habit of shallow, mouth breathing, the Ancient Ayurvedic Rishis (sages) outlined in detail the remarkable benefits of breathing as nature intended – like the great yogi’s.
Learn the how and why of proper breathing and how it can be used in exercise (even in high level exercise) to transform your enjoyment of exercise and create alpha zone or flow states. Also get the benefits of pranayama, mind-body integration, lymphatic flow, production of nitric oxide, efficient waste removal, heightened Prana or life force in both mind and body, optimized function of your internal organs, spine health and higher, more refined levels of awareness and spiritual integration.
More resources at markbunn.com.au
The Tremendous Trio solve the case of the Woman With Foul Steatorrhea, and reveal breakdown of the glycocalyx associated with severe and fatal malaria.
Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin
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Woman 30 yo, traveled to DR, went to tourist part. On return for yearly physical, asked about her chronic constipation. She said does not have it any more, has normal bowel habits. A few weeks after her return this occurred. Primary care doc was intrigued, sent off some tests. Found Entamoeba hartmanni. What might the doc have done? What were the consequences of infection?
Send your case diagnosis, questions and comments to twip@microbe.tv
Music by Ronald Jenkees
Brief introduction to the reasons nutritional supplementation can be useful and the specific amino acids which support vascular health.
In this episode, Kathy and I will reveal "Why Better Breathing Doesn’t Always Lead to Better Health."
Here are 7 of these reasons. Please listen to the recording to find out more.
1. You can’t control your breathing when you’re sleeping
2. You don’t know you’re not breathing well
3. You can’t control your sleep position or posture at night
4. Not all breathing is equal
5. The oxygen myth: Lack of breathing, not lack of oxygen
6. Despite high levels of oxygen in your bloodstream, it may not reach certain areas of your body under stress
7. Stress-Breathing Paradox
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Shownotes
The TWiPwalas solve the case of the Woman with a Worm in Her Eye, and discuss the role of nitric oxide in the resistance of rats to Schistosoma japonicum.
Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin
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This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. See what’s on the menu this week and get 3 meals free with your first purchase – WITH FREE SHIPPING – by going to blueapron.com/twip.
Seen at Columbia Medical Center, a crossover. Woman in 30s returns to US after 2 years in Peace Corp, Cameroon and Gabon. On medical exam 2 years earlier: eosiniphilia noted, no diagnosis reached. Now comes to NYC 2 years later to attend grad school, again eosinophilia noted. Asymptomatic.
Send your case diagnosis, questions and comments to twip@microbe.tv
Music by Ronald Jenkees
The TWiP Titans solve the case of the Man from Queens with a Blister Burster, and explain the role of inflammatory monocytes during Leishmania infection of the skin.
Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin
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This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. See what’s on the menu this week and get your first 3 meals free with your first purchase – WITH FREE SHIPPING – by going to blueapron.com/twip.
Patient seen by Daniel in India, 18 yo Islamic college student, left home, living in dorms in south, Hindu couple prepare meals, called dorm parents. He is being seen because developed lump in left side of neck, 1-2 cm mass. Previously completely healthy, no med/surg, no allergies. Prays multiple times a day, observes dietary restrictions. Afebrile, normal, but has 2 cm firm nontender lump inside interior portion of sternocleido mastoid muscle. Not tender. End of November, rainy season. No screens on dorm windows. No animal contact. Ultrasound done, and was helpful. Noticed in his neck over several weeks.
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Music by Ronald Jenkees
Dr. Raymond Benza is a cardiologist in Pittsburgh, Pennsylvania and is affiliated with multiple hospitals in the area, including Alle-Kiski Medical Center and Allegheny General Hospital. He has been in practice for more than 20 years. Dr. Benza discusses the benefits of inhaled iNO (nitric oxide) in patients with pulmonary hypertension.
My name is Dr. Raymond Benza and I'm a PH clinician and researcher.
We're going to talk a little bit about nitric oxide. It's importance in pulmonary hypertension and in some of the interesting clinical work that we're doing with this particular molecule.
Nitric oxide is a molecule that the body utilizes to keep the blood vessels in the lungs wide open and rushing with blood. In patients with pulmonary hypertension, the blood vessels in the lungs no longer make this molecule. We don't know why. We think it may be related to some genetic predisposition, but when the absence of this molecule, the blood vessels constrict and result in pulmonary hypertension. This is probably the most potent blood vessel dilator known to mankind. That's why it's so essential to have this in the body of people who have pulmonary hypertension because it really in essence, can bring the blood vessels back to a normal tone, and ease the stress off their heart.
This molecule we know can be delivered therapeutically and actually we've had chemical forms of this compound that's been available for use for many years. The problem with it is that it's delivered as a gas, and people have to inhale it. The tanks that are required to deliver this are huge. There's no way people can walk around with these things. We've only been able to use this life saving medication in the hospital when someone is very, very sick with pulmonary hypertension and in many instances, it's been life saving. It's gotten people out of the crutch and allowed them to get put on regular medications and have an improved outcome.
Some pretty smart engineers figured out a way to miniaturize the cylinders so they can be carried in a hip like structure and people can walk around with it and they can be delivered just like they wear oxygen. That's essentially the essence of the study that we completed. We looked at the first ambulatory form of nitric oxide for treatment of pulmonary hypertension.
The study was conducted over several years and patients who were already on therapy for pulmonary hypertension but who had not yet met their clinical goals, meaning they were still breathless when they were trying to do the things they like to do every day, were randomized to get this medication or not. Then we saw how they did. At the end of the day, the patients who received the gas, if they used it correctly, meaning they used it all day and didn't take frequent breaks from it, seemed to walk longer and have improvements in the way their heart circulates blood.
Obviously it was very dependent upon patient compliance. How often they used it, how long they used it, and if they used it throughout the day as opposed to in very short cycles. I think we've shown at least a signal that this form of walking around medicine might be useful in patients with pulmonary hypertension to help them live longer and breathe better.
The six minute walk test is really one of the most simple tools that we have to measure someone's functional capacity who is stricken with diseases like heart failure. It's simple having someone walk up and down a hallway for six minutes and to see what kind of distance they can attain in that six minutes.
Obviously, someone who can walk a longer distance in six minutes, has a better functional capacity that someone who can't walk very far in six minutes. It's really been used as the gold standard for measuring outcome and pulmonary hypertension for many, many, many years. The smaller study that we did and that's being presented at the International Society of Heart and Lung Transplant meeting is we used this ambulatory form of nitric oxide during patient's six minute walk tests. We found that those patients who utilized it during a walk, had much improved functional capacity than those who didn't.
Interestingly, in the patients that we looked at, they had another novel in dwelling hemodynamic monitor called a CardioMEMs monitor that monitors their pulmonary pressures 24 hours a day. We were able to see what their pulmonary pressures did with exercise and those who did or did not wear their nitric oxide. Those who did seemed to have a much better hemodynamic response to walk than those who didn't.
Presently, patients who are using the inhaled nitric oxide still have to take their PH medications. We have yet to determine whether people can be weaned off these medications and just use the nitric oxide. Luckily, and the medication has very, very few side effects, which is similar to what we've seen when we utilize the gas in the hospital. It doesn't cause your blood pressure to be low. It doesn't cause any strange neurological effects and it's usually very well tolerated.
My name is Dr. Raymond Benza and I'm aware that I'm rare.
Learn more about pulmonary hypertension at phaware365.global. Never miss an episode with the phaware® podcast app. Follow us @phaware on facebook, twitter, instragram, youtube & linkedin #phaware #phawareMD
Dr. Raymond Benza is a cardiologist in Pittsburgh, Pennsylvania and is affiliated with multiple hospitals in the area, including Alle-Kiski Medical Center and Allegheny General Hospital. He has been in practice for more than 20 years. Dr. Benza discusses the benefits of inhaled iNO (nitric oxide) in patients with pulmonary hypertension.
Learn more about pulmonary hypertension at phaware365.global. Never miss an episode with the phaware® podcast app. Follow us on facebook, twitter, instagram, youtube & linkedin @phaware #phaware #phawareMD
Per Bredmose discusses the use of inhaled nitric oxide (iNO) in retrieval medicine and critical care. He explains why iNO is useful for retrieval and transport of the critical respiratory failure patient.
iNO is not a magic bullet, but rather a bridge that will help you get to where you need to go when treating a patient.
Furthermore, it can be useful in both pre-hospital and in hospital care.
It is an endothelial derived potent short acting vasodilator mainly found in the pulmonary system. It also exists in other areas of the body. When nitric oxide is delivered via the inhaled route it has local effects only, with no systemic effects.
Most people will be familiar with the use of iNO in persistent pulmonary hypertension of the newborn.
However, there are other uses which are more “off label”. For instance, take the case of severe ARDS lungs in pre-hospital settings. These patients present challenges in retrieval for several reasons, including the retrieval ventilation systems being inferior when compared to hospital systems.
Of course, you could turn straight to ECMO. However, setting up ECMO takes time and is complex. It requires a large amount of equipment, skilled operators, and room. Nitric oxide can act as a bridge.
Nitric oxide is simple to use. It is an extra gas that goes into the ventilatory circuit. It is accessible, can be used in any vehicle, is easy to transport, and fast to grab and use. Much faster than a big ECMO set up or retrieval.
A lot of places have stopped using iNO and it has gained something of a bad reputation. The main reason for deleterious effects appears to be kidney injury. Per posits that this may be due to an increased length of time using the drug. Therefore, he advises caution.
Per concludes by explaining other conditions where iNO may be used as an adjunct to standard therapy. These situations include pulmonary hypertension, non-thrombotic pulmonary vasoconstriction, and pulmonary emboli.
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