Physician's Weekly offers in-depth interviews with the most highly respected experts in the medical community, weighing in on landmark research, trending topics, and offering insight on issues affecting everyday medical practice. In collaboration with Medicom Medical Publishers, Physician's Weekly Podcast continues to maintain the company's nearly 40 year reputation as a trusted resource for healthcare professionals.
inDEPTH: Excess Nitrogen in the Body
With most Americans recently celebrating Thanksgiving by joining friends and family over a large, turkey-heavy celebratory meal, we take an inDEPTH look at how our bodies deal with excess nitrogen.
Animals mostly excrete excess nitrogen as ammonia, urea, or uric acid, which is produced during protein metabolism. Ammonia is the direct waste produced as a byproduct of protein metabolism by all animals. But because of its toxicity, many animals convert ammonia into a less toxic form. The major excretory product in humans is urea, which is excreted in urine by the kidneys.
Fun fact: birds and reptiles have evolved the ability to convert toxic ammonia into uric acid, which packs four nitrogens into each molecule, compared with two nitrogens in each human urea molecule. Not only is that a much more efficient means of excreting nitrogen, uric acid is a white crystal precipitate, which is why guano is white and makes such an excellent fertilizer.
Humans have many diseases caused by excess nitrogen. Later in this episode, we will talk with Dr. Julien Baruteau, from the Metabolic Medicine Department, Great Ormond Street Hospital for Children NHS Foundation Trust, in London, UK, about how his lab goes about modeling urea cycle disorders using patient cells. But first, we speak with Dr. Michael Pillinger (NYU Grossman School of Medicine, NY), about how gout flares result from an innate immune response against monosodium urate crystal deposits, and about his recent results from the PIVOTAL study, presented at the ACR Convergence 2022 meeting.
inDEPTH: The LDL-C Revolution
We are entering holiday season, and as a recent study published in the journal Atherosclerosis recently showed, celebrating the winter holidays is associated with up to 20% higher levels of total and LDL cholesterol, as well as up to a 15% higher risk for hypercholesterolemia in the general population. Although the holiday season is not a great time for a diagnosis of hypercholesterolemia, it is a great time to start talking about some of the revolutionary new methods to treat hyperlipidemia.
To take up that challenge, we take an in-depth look at two new studies just reported at the American Heart Association (AHA) Scientific Sessions 2022, held in Chicago, Nov 5-7. Statins are first-line agents for reducing LDL cholesterol (LDL-C) and the risk of major cardiovascular events. In addition, biotechnological advancements in medication therapy have led to the development of inclisiran, a recently approved twice-yearly injectable agent to help patients with heterozygous familial hypercholesterolemia and clinical cardiovascular disease on a maximally tolerated statin to reach LDL-C targets. Inclisiran has demonstrated robust LDL-C reduction in clinical trials in combination with a favorable safety profile; however, the effect on cardiovascular clinical outcomes still remains under evaluation. First, Professor Kausik “Kosh” Ray (Imperial College London, UK, and President European Atherosclerosis Society) talks about the ORION-3 trial. Then, Professor Jeff Anderson (Intermountain Heart Institute, Utah) discusses the VICTORION-INCEPTION Trial.
Vedel-Krogh S, Kobylecki CJ, Nordestgaard BG, Langsted A. The Christmas holidays are immediately followed by a period of hypercholesterolemia. Atherosclerosis. 2019 Feb;281:121-127.
Ray K, et al. Efficacy and Safety of Twice-Yearly Subcutaneous Inclisiran in Patients With High Cardiovascular Risk and Elevated Low-Density Lipoprotein Cholesterol up to 4 Years-The ORION-3 Trial. Presented at the American Heart Association Scientific Sessions, Nov 5-7th, 2022.
Anderson J, et al. A Randomized Study to Compare LDL-C-Lowering Effects of Inclisiran With Usual Care vs Usual Care Alone in Patients With Recent Hospitalization for an Acute Coronary Syndrome: Rationale and Design of the VICTORION-INCEPTION Trial. Presented at the American Heart Association Scientific Sessions, Nov 5-7th, 2022, Abstract 10851.
An inDEPTH Look at Movember: Updates in Prostate Cancer
Urological surgeon Phillip Cornford, BSc(hons), MB, BS, FRCS(Urol), MD, FEBU, (University of Liverpool) discusses unmet needs in early prostate cancer detection and exciting new techniques for advanced disease. Also, biotech industry expert Annaleen Daemen speaks about various innovative approaches to treatment-resistant prostate cancer, including the prospect of genome-driven diagnostics leading clinical care decisions.
inDEPTH: Prevention in Primary Care
This week, we take a deep dive into the benefits and problems facing primary care physicians, through the lenses of a family physician and an academic team. Kevin Grumbach, MD, explains to PW Editorial Board Member Alex McDonald, MD, why change is needed now in primary care or the “critical sector to the health of our people is about to implode.” Also, Steven Atlas, MD, discusses his JAMA study results, which turned up some important deficiencies in systems for managing abnormal cancer screening test results that can ultimately improve prevention in primary care.
Primary Care for Mother Earth, MSO Pros & Cons
Dr. Husein Moloo discusses the impact of medicine’s carbon footprint on climate change and how to lower it. Also, Dr. MedLaw details management service organizations: what to look out for and when they can help your practice.
Heart Defects & Fish, Should Docs Apologize?
This episode, we have two really interesting and very different interviews. Physician’s Weekly speaks with our regular contributor, a registered physician and medical malpractice attorney, who goes by the alias Dr. MedLaw. We explore when and how it is appropriate for physicians to apologize… or not.
But first, Princeton University Professor Rebecca Burdine, PhD, speaks about the value of modelling rare diseases. Dr. Burdine uses small zebrafish for her studies, and you would be amazed at how well these small fish can model diseases, and even be used in diagnostics. Dr. Burdine is also a caregiver to her daughter, who has the rare disease Angelman Syndrome, which Dr. Burdine just happens to study. She provides excellent insights into the value of studying rare diseases.
Willgoss T, Cassater D, Connor S, Krishnan ML, Miller MT, Dias-Barbosa C, Phillips D, McCormack J, Bird LM, Burdine RD, Claridge S, Bichell TJ. Measuring What Matters to Individuals with Angelman Syndrome and Their Families: Development of a Patient-Centered Disease Concept Model. Child Psychiatry Hum Dev. 2021 Aug;52(4):654-668.
Cheng KC, Burdine RD, Dickinson ME, Ekker SC, Lin AY, Lloyd KCK, Lutz CM, MacRae CA, Morrison JH, O'Connor DH, Postlethwait JH, Rogers CD, Sanchez S, Simpson JH, Talbot WS, Wallace DC, Weimer JM, Bellen HJ. Promoting validation and cross-phylogenetic integration in model organism research. Dis Model Mech. 2022 Sep 1;15(9):dmm049600.
Bird LM, Ochoa-Lubinoff C, Tan WH, Heimer G, Melmed RD, Rakhit A, Visootsak J, During MJ, Holcroft C, Burdine RD, Kolevzon A, Thibert RL. The STARS Phase 2 Study: A Randomized Controlled Trial of Gaboxadol in Angelman Syndrome. Neurology. 2021 Feb 16;96(7):e1024-e1035.
Patterson VL, Burdine RD. Swimming toward solutions: Using fish and frogs as models for understanding RASopathies. Birth Defects Res. 2020 Jun;112(10):749-765.