Dr. Howard Smith Oncall

Vidcast:  https://youtu.be/rjHHFKVY7d8   UV light is often unable to penetrate all areas of the CPAP hoses, masks, and connectors, and disinfection will fail.  The use of UV light products can also lead to accidental exposure to the light if improper shielding is used.  Such exposure can produce eye injuries and skin burns.   Cleaners that employ ozone for disinfection often leak releasing the gas at unsafe levels into the air.  Also, the gas levels may remain at unsafe levels in the CPAP machine, hoses, and masks even after the recommended waiting periods following the cleaning cycle.   The FDA recommends that you refer to your CPAP machine manuals for recommended cleaning instructions.   https://www.fda.gov/medical-devices/safety-communications/potential-risks-associated-use-ozone-and-ultraviolet-uv-light-products-cleaning-cpap-machines-and   #cpap #uv #ozone

  Vidcast:  https://youtu.be/8Z05fifoFNY   The first lower cost generic albuterol inhaler is now available for use by children and adults ages 4 years and over.  This type of metered inhaler has been difficult for generic manufacturers to duplicate.  Now that a safe and effective alternative to the branded Pro-Air inhaler is available, the price competition may take place.   https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-proair-hfa   #asthma #pediatrics #albuterol #proair  

  Vidcast:  https://youtu.be/luevwJ5UWtQ   Excess weight triggers the same degenerative changes in our cells, organs, and entire body as aging.  A new review article from Canada’s Concordia University analyzed more than 200 studies that examined this linkage.   Both obesity and aging trigger cell death in the heart, liver, kidneys, and brain.  Both conditions limit our body’s ability to flush away damaged cells leading to cancer, cardiovascular disease, and dementia.  Then too, obesity speeds up the aging of our body’s systems including our immune system.  With altered immunity, humans are more susceptible to disease including viral illness such as the flu and CoVid19.   To remain young and alive in so many ways, control your weight.    Bjorn T. Tam, Jose A. Morais, Sylvia Santosa. Obesity and ageing: Two sides of the same coin. Obesity Reviews, 2020; DOI: 10.1111/obr.12991   #obesity #aging #immunity #cancer #heartdisease #dementia  

  Vidcast:  https://youtu.be/ZcBAZGaj-5U   Caffeinated drinks help you think faster and focus better, but they can’t help you think outside the box.  University of Arkansas psychologists draw this conclusion following their study of 80 volunteers half of whom received 200 mg of caffeine, the amount in a strong cup of coffee.   Those receiving the caffeine showed improved problem-solving, better focus, and enhanced alertness.  Caffeine did not improve the subject’s creative thinking or memory.   So down that coffee, tea, or energy drink to help you finish your taxes or that math worksheet.  If you’re writing the world’s next great novel, though, caffeine will push you to the finish line but it won’t improve your plot.    Darya L. Zabelina, Paul J. Silvia. Percolating ideas: The effects of caffeine on creative thinking and problem solving. Consciousness and Cognition, 2020; 79: 102899 DOI: 10.1016/j.concog.2020.102899   #caffeine #creativity #problemsolving

  Vidcast:  https://youtu.be/NYEsUk9CufM   You’re worried you have CoVid19.  You’re feeling warm.  You have throat soreness.  You have a cough.  What to do?     Take your temperature follow it daily as you track your symptoms.  If your oral temp is consistently above the normal 98.6˚F and your symptoms are persistent or escalating, call your doctor or the hospital and ask next steps.   When you do, they will have you came to the hospital or an isolation unit for a checkup and testing.  If  CoVid19 is suspected, isolate yourself.  If you’re with others, wear a mask or make one from your scarf.     Even if an official CDC viral test isn’t available, professionals can test you.  A chest cat scan for pneumonia  has a diagnostic sensitivity of 97% for viral pneumonia.   A white blood count revealing low eosinophils occurs in 79% of CoVid positive pneumonia patients but in only 36% without the virus.   Expect to have a workup and close observation at the facility or at home if you’re well enough.  Studies of patien

  Vidcast:  https://youtu.be/zhAmBseKJ4w   Here are the latest CDC travels warnings.  None but essential travel to China, Iran, South Korea, and Italy.  None but essential travel for older persons or those with chronic disease to Japan.     Considering the Chinese epidemic experience, you can predict that these destinations will likely not be suitable recreational travel destinations for another 4-6 months or more.  Should you recover from a verifiable case of CoVid19, you will likely be immune to further infection.  That is, if the virus fails to mutate into other forms capable of reinfecting you, you could then safely travel to these zones earlier.  Stay tuned for information about CoVid19 mutations.   https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html https://travel.state.gov/content/travel/en/traveladvisories/traveladvisories.html/   #covid19 #coronavirus #epidemic #pandemic

  Vidcast:  https://youtu.be/wc_ai6Ni73Q   Preventing CoVid19 from harming you and your family will involve personal and community efforts.  Personally, you must guard against contracting the virus and passing it on to others.  That involves keeping your fingers and hands from your face, repeated soap and water handwashing or use of alcohol hand sanitizers, avoid touching surfaces likely to harbor contaminated secretions like door handles and your phone, cough and sneeze into tissues, and stay home from work if you feel sick.   Stay away from crowded places if you can, and take special precautions in subway and rail stations as well as airports.  If you can, shop at odd hours.  Walk any walkable distances, and use your automobile for longer travel where feasible.   The Chinese instituted an early warning system for personal infection: a mandatory daily temperature check.  This is easy enough for all of us to do.  There are even electronic thermometers that link to your phone for as little as $11.    At the fi

  Vidcast: https://youtu.be/-rdbcwd4MlM   Efforts to stem the spread of CoVid19 have been successful in China.  The measures include: entertainment venues closed; public gatherings canceled; intra-city transit, mass and personal, halted; travel to and from the city prohibited;  and entire city shutdown and lockdown.     Chinese cities that proactively employed similar measures before a first case report, enjoyed 37% fewer cases in the first week after that case report.  The most effective measures were stopping intra-city transit and closure of public entertainment and gathering.   Transmission Control Efforts: https://www.medrxiv.org/content/10.1101/2020.01.30.20019844v3.full.pdf https://gizmodo.com/china-orders-mandatory-coronavirus-checks-in-wuhan-and-1841498598   #covid19 #epidemic #pandemic #coronavirus

  Vidcast:  https://youtu.be/Q9a4NQc35xI   According to pre-published data online, as of late February there are 75 registered studies of CoVid19 disease underway.  97% are headed by Chinese organizations.  Only 11 trials have begun patient recruitment.  Trials include those testing Western medicine, Eastern medicine, and combinations.     Two already initiated studies focus on the anti-viral nucleotide analog remdesivir: one involving those with mild/moderate disease and the other on those with severe disease.  In each 60 patients were treated with active agent and 60 were control receiving conventional supportive therapy only.  Studies are expected to end on 4/27/2020.  The expectation that this drug will help is based on test tube results that show it has a marked anti-viral effect.     Other studies employing Western medicine are testing various other anti-viral agents alone and in combination.  Once more information about them is available, I will bring it to you.   Clinical trials: https://www.medrxiv.

  Vidcast:  https://youtu.be/81G-oRa44pU   The CoVid19 virus is moderately contagious. The CoVid19 reproductive number, number of vulnerable  persons expected to be infected from a single infected person, is 2 -3.  This number may be as high as nearly 7.  In comparison, the number for measles is 12-18, diphtheria  6-7, HIV 2-5, the flu 2-3 and Ebola 1.5-2.5.     The incubation period is 2-14 days with a 5-6 day average.  The cases in each affected area double every 2 days.  The institution of travel and mass gathering restrictions has had a profound positive impact on the reproductive number and viral spread according to unpublished data on the MedRxiv site.   You can track the spread of CoVid19 around the world and through the US on the excellent Johns Hopkins CVid19 web page:   Johns Hopkins Live Coronavirus Stats: http://coronaviruslivestats.com Reproductive rate of CoVid19: https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1.full.pdf Incubation period: https://www.medrxiv.org/content/10.1101/20

  Vidcast:  https://youtu.be/Nz60NienuxM   Chinese mathematicians studying the CoVid19 disease dynamics predict that the hardest hit area, Wuhan, will see new cases trail off in April.  That’s a full 4 months after the beginning of disease transmission.  Their online, as yet unpublished data predicts, that for less hard hit Beijing and Shanghai, cases will cease about now in early March.  That’s about 3 months from the onset.  CoVid19 will decline in remainder of China by mid-March, that’s about 2 months from the beginning.     So once CoVid19 arrives in a region, it will be a 4 month threat.  To be on the safe side, double that for elective travel plans if you are in a CoVid19-vulnerable group due to age or health.   Length of epidemic:  https://www.medrxiv.org/content/10.1101/2020.02.16.20023465v1.full.pdf   #covid19 #coronavirus #epidemic #pandemic  

  Vidcast:  https://youtu.be/AlG6nsoVV5Y   If you completed your childhood tetanus shot series, the old DPT and the more recent DTap, you are protected for life against tetanus, diphtheria, and pertussis or whooping cough.  Infectious disease researchers at the Oregon Health and Science University just published their analysis of World Health Organization data comparing illness in countries that do or do not recommend adult booster vaccinations.   The crunched numbers covering more than 11 billion person-years failed to show any reduction in tetanus or diphtheria in those populations that received vaccine boosters every 5 to 20 years.  It appears that childhood vaccinations, if completed, stimulate sufficient immune memory for a lifetime of protection.    Ariel M Slifka, Byung Park, Lina Gao, Mark K Slifka, Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules, Clinical Infectious Diseases, , ciaa017, https://doi.org/10.1093/cid/ciaa017   #tetanus #diphtheria #dpt #dtap #boosters  

  Vidcast:  https://youtu.be/MpvcfzFj7j8   Metformin, an oral drug for type 2 diabetes, enhances the therapeutic benefits of steroids while reducing their side effects.  A randomized, double blind British study just published in The Lancet looked at 53 participants taking 10-20 mg of prednisone over a 4 month period.   Those also receiving an escalating dose of metformin up to 850 mg 3 times a day, enjoyed improved anti-inflammatory steroid effects and reduced  metabolic side effects as well as fewer bouts of infection and a lower rate of hospitalization for complications.   Chronic steroid therapy is a godsend for those with arthritis, asthma, and cancer.  Adding metformin may just make it more effective and tolerable.    The Lancet Diabetes & Endocrinology (2020). DOI: 10.1016/S2213-8587(20)30021-8 , http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30021-8/fulltext   #steroids #metformin #arthritis #copd #asthma  

  Vidcast:   https://youtu.be/jMcs8Yu3fs8   Regular aspirin use lowers your risk of fractures and osteoporosis.  A just published Australian meta-analysis of 12 studies reviewed data from more than half million persons.   The analysis revealed a 17% lower risk of fracture at any site, long bones and spine, for those taking aspirin.  Aspirin users enjoyed higher bone mineral densities in their hips as well as in their lumbar spines.  The effect seemed independent of aspirin dosage though most were likely on low dose regimens.   Aspirin works this magic through its anti-inflammatory powers.  The investigators stop short of recommending a low dose regimen for osteoporosis prophylaxis, but, if your doctor agrees you can take it, it can’t hurt.    Barker AL, Soh S, Sanders KM, et al Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies BMJ Open 2020;10:e026876. doi: 10.1136/bmjopen-2018-026876   #aspirin #osteoporosis #fracture

  Vidcast:  https://youtu.be/lasjqmeLz0s   Drivers of luxury vehicles are significantly less likely to yield for pedestrians.  This is the conclusion of a new study from the University of Nevada..  The researchers studied the behavior of 461 autos as they negotiated several Las Vegas crosswalks.   Overall, only an abysmal 28% of cars yielded to crossing pedestrians.  The odds of a car yielding diminished some 3% for every $1000 escalation in its dollar value.   It gets worse. All cars yielded less often for men than women, only 24 versus 31%, and less often for non-whites than whites 25%, versus 31%.   Bottom line: get your head out of your phone when crossing.    CourtneyCoughenourPhDaJamesAbelarBSaJenniferPharrPhDaLung-ChangChienPhDaAshokSinghPhDb.  Estimated car cost as a predictor of driver yielding behaviors for pedestrians.  J. Transport & Health. https://doi.org/10.1016/j.jth.2020.100831   #automobiles #crosswalks #luxury

  Vidcast:  https://youtu.be/JK_O-SRM5sg   Downing more food earlier in the day can help your weight control efforts.  Researchers at Vanderbilt University draw this conclusion from their small but detailed metabolic study of middle aged subjects eating 3 meals a day.   When the participants eat their third meal of the day later in the evening, they burned less fat and stored rather than expended calories.  Over time, this eating pattern and its metabolic consequences will trigger weight gain.   This study is bad news for those who love dining late into the evening.  One way to counterbalance this effect of your body’s biologic clock is to consume fewer total calories: particularly those in fried foods and desserts.    Kevin Parsons Kelly, Owen P. McGuinness, Maciej Buchowski, Jacob J. Hughey, Heidi Chen, James Powers, Terry Page, Carl Hirschie Johnson. Eating breakfast and avoiding late-evening snacking sustains lipid oxidation. PLOS Biology, 2020; 18 (2): e3000622 DOI: 10.1371/journal.pbio.3000622   #circad

  Vidcast:  https://youtu.be/--0-xO5Nnho   Those who work from home are just as likely to win promotions as those who toil daily at the office.  A new study from the Rensselaer Polytechnic Institute focused on survey responses from 405 full-time employees analyzing percentage of work time telecommuting, promotions, salary growth, and company telecommuting attitude.   The most important variable is a company’s acceptance of telecommuting.   Given that,  telecommuters enjoyed promotions as often as onsite workers.   To earn equal pay bumps, however, telecommuters must enthusiastically demonstrate their commitment to organizational success.  In this regard, face time with managers is a must.   Telecommuting offers better work-life balance and less time inhaling inhaling traffic and mass transit pollutants.    Timothy D. Golden, Kimberly A. Eddleston. Is there a price telecommuters pay? Examining the relationship between telecommuting and objective career success. Journal of Vocational Behavior, 2020; 116: 103348

  Vidcast:  https://youtu.be/iBYEZb0dOug Dr. James Robb, former molecular virologist at UC-San Diego and the first molecular virologist to characterize the coronavirus genum, is sharing the precautions he is personally taking to avoid the CoVid19 virus.   No handshaking: fist bump, elbow bump, bow ok. Use your knuckles to push buttons. Operate public devices like gasoline pumps with a disposable glove or paper towel. Open doors with your closed fist, hip, or a glove. Especially store and postoffice doors. Have disinfectant wipes and use them to wipe grocery store cart handles and seats for kids. Handwashing: 20 seconds with soap/water or, second best, >60% alcohol hand sanitizer that you keep at very door, in your auto, and in your coat. Sneeze into a disposable tissue rather than elbow.  The clothing will contain infectious virus for more than a week. A disposable surgical mask won’t protect you from a direct cough/sneeze.  It’s a reminder to keep your hands away from your nose and mouth that we all tend to

  Vidcast:  https://youtu.be/gjn9KMa3cHc   Third and fourth graders playing sports wolf down 25% more calories after their game than they burn during the game.  Utah’s Brigham Young University studied kids playing 189 games of soccer, flag football, baseball, and softball.   The children burned 170 calories during the game but gorged on 213 calories afterwards.  The calorie count surged due to sugary drinks like Capri Sun and Kool-Aid as well as cookies and cakes.   Sports participation is wonderful for growing children’s’ bodies, but it won’t stem the obesity crisis unless kids consume fewer calories than they burn.  Substitute iced water or real fruit juices for the sugar drinks and offer fruit in place of pastries.    Natalie Bennion, Lori Andersen Spruance, Jay E. Maddock. Do Youth Consume More Calories than they Expended in Youth Sports Leagues? An Observational Study of Physical Activity, Snacks, and Beverages. American Journal of Health Behavior, 2020; 44 (2): 180 DOI: 10.5993/AJHB.44.2.6   #youthsport

  Vidcast:  https://youtu.be/POdAfXsCW28   Remdesivir, Gilead Pharmaceutical’s experimental drug coded GS-5734, is an antiviral nucleotide analog that currently shows the most promise for treating our current novel coronavirus disease.  A just published study from from Canada’s University of Alberta explains how this pharmaceutical, originally developed to treat Ebola, actually works.   Remdesivir is metabolized to remdesivir-triphosphate that vigorously blocks the participation of adenosine triphosphate, better known as ATP, in the synthesis of new viral RNA.  No new viral RNA, no viral replication and the disease fades.   Remdesivir, affectionately called RDV, has shown significant clinical effects on CoVid19 victims in China.  More extensive testing is underway but so far, it’s all good news.    Calvin J Gordon, Egor P Tchesnokov, Joy Y. Feng, Danielle P Porter, Matthias Gotte. The antiviral compound remdesivir potently inhibits RNA-dependent RNA polymerase from Middle East respiratory syndrome coronavirus