Dr. Howard Smith Oncall

Vidcast:  https://www.instagram.com/p/C4qlp88rrZV/ The Consumer Product Safety Commission and Best Buy are recalling Insignia Air Fryers and Air Fryer Ovens.  These air fryers overheat and melt their own handles, while the air fryer ovens overheat and shatter the oven door glass.  All this leads to fires, burns, and lacerations. About 187,400 fryers and fryer ovens were sold in the US, and about 99,900 were sold in Canada at Best Buy stores and online at BestBuy.com, eBay.com, and other marketplaces. Stop using these fryers and go online to recallrtr.com/airfryer to retrieve instructions regarding submission of photos including pics of your unit with model number shown, purchase receipts, and verification of unit destruction. For more information, call BestBuy  at 1-800-566-7498. https://www.cpsc.gov/Recalls/2024/Best-Buy-Recalls-Insignia-Air Fryers-and-Air-Fryer-Ovens-Due-to-Fire-Burn-and-Laceration-Hazards #insignia #airfryer #fryeroven #overheating #handles #doorglass #recall

Vidcast:  https://www.instagram.com/p/C4qkiPurK-Q/ The Consumer Product Safety Commission and the US boiler company are recalling U.S. Boiler, New Yorker Boiler, Advantage, FORCE and Archer brand gas-fired hot water residential boilers.  The blocked vent shutoff switch can fail with boilers installed above 5,400 feet in altitude leading to toxic levels of carbon monoxide output and poisoning of household occupants. About 2500 of these boilers have been installed by heating and plumbing contractors nationwide between February 2009 and November 2023. Immediately contact US Boiler by phone at 1-888-432-8887  or via email at info@usboiler.net to schedule a free boiler repair.  If you are using these boilers before repair, you should use a CO monitor. https://www.cpsc.gov/Recalls/2024/US-Boiler-Company-Recalls-Gas-Fired-Hot-Water-Residential-Boilers-Due-to-Carbon-Monoxide-Poisoning-Hazard #usboiler #boiler #shutoff #carbonmonoxide #poisoning #recall

Vidcast:  https://www.instagram.com/p/C4gjZVdrHew/ The Eli Lilly company is now selling many of its drugs, including the sought-after diet drug tirzepatide, branded Zepbound, directly to you at low prices.  This cuts out the intermediaries including the wholesaler, pharmacy benefit managers, pharmacies, and insurance companies who tack on additional costs as the medications pass through their hands. The new program called LillyDirect particularly helps those without health insurance.  The program offers, for example, Lilly’s highly popular diet drug tirzepatide for $550/month, about half of the drug’s list price.  This new program joins other direct-to-consumer operations run by Walmart, Costco, Amazon, and billionaire Shark Tank panelist Mark Cuban’s Cost Plus. All of these programs follow a trend that puts prescription drugs into the hands of consumers for lower prices.  Besides the ones already mentioned, there is the GoodRx coupon opportunity that often permits you to purchase medications for less mon

Vidcast:  https://www.instagram.com/p/C4gic7bLroi/ The first coronary balloon catheter that not only opens these critical heart-feeding arteries but helps to keep them open has now won FDA approval for marketing.  Boston Scientific’s Drug Coated Balloon or DCB, coated with paclitaxel,  reduces the risk of vessel reblocking during a one year period by 38%.   The superiority of this DCB, branded as Ranger, was substantiated in a multisite study of 480 patients led by Harvard’s Beth Israel Deaconess cardiologists.  The novel balloon is coated with paclitaxel, an anti-cancer drug that inhibits growth and overgrowth of blood vessel lining cells.  The novel balloon prevented all blockage of the stents and led to a 49% lower risk of heart attack.  The data revealed no paclitaxel toxicity and adverse reactions. These new balloons will be available in the US this spring.  They are already on the European market. https://jamanetwork.com/journals/jama/fullarticle/2816073 #coronary #balloon #stenosis #paclitaxel #d

Vidcast:  https://www.instagram.com/p/C4ghnWwr6iL/ During this season of award shows, the medical community won’t be left out.  One dermatology professional association, the American Contact Dermatitis Society has named sulfites the Allergen of the Year for 2024. Sulfites as a family of chemicals can be present in foods, drinks, cosmetics, and therapeutic skin creams both over-the-counter and prescription.  When sulfites touch the skin in susceptible individuals, they can induce and repeated trigger local allergic reactions that you recognize as rashes, tiny blisters, and good old fashioned red bumps that can be devilishly itchy.  This type of allergic reaction forms slowly snd usually does not lead to hives or life-threatening anaphylactic reactions.  The reactions most commonly occur on the hands and then on the chest, abdomen, back, and extremities. The sulfite family includes sodium disulfite, sodium sulfite, ammonium sulfite, and potassium sulfite.  These chemicals serve as preservatives and therapeu

Vidcast:  https://www.instagram.com/p/C4ggwWnr9X4/ Novo Nordisk, the Danish manufacturer of the diabetes drug semaglutide, repurposed for weight loss and branded as Wegovy and Ozempic, is once again screaming a warning to all those who are searching for this drug in a market where it is in very short supply.  While these warnings have been coming from the company and the FDA since late last year, Novo is now working with multiple countries as well as the US to stem the tide of counterfeit and dangerous semaglutide copycats.  These fakes are circulating in 16 or more countries, and they can be dangerous.   Some of the fakes deliver inaccurate levels of semaglutide from defective dispensers, and that leads to unpredictable and inaccurate doses that trigger life-threatening drops in blood sugar.  In other cases, counterfeits are created by compounding pharmacies that use raw semaglutide obtained from questionable sources around the world.  Lilly has found bacteria, other impurities, and non-medicinal chemical

x https://www.instagram.com/p/C4gTotpLcsd/ Those children with autism spectrum disorder, ASD, commonly carry the SCN2A genetic variation.  This mutation that affects the flow of electrical signals in and out of brain cells has broad impacts on the developing neurologic system.   These include a likelihood of seizures but also changes to the eyes’ motor controls.  UC-San Francisco neurologists have exploited these changes to the so-called oculomotor system to identify children with the SCN2A mutation and and autism in its many forms.   Using an eye tracking device that visualizes a child’s eye movement when asked to focus on a person or object, the child without the mutation consistently does so which a child with SCN2A and autism cannot focus consistently. This mutation is also associated with other neurologic issues, but the oculomotor test is a rapid gateway into the diagnosis of autism spectrum disorder. https://www.cell.com/neuron/abstract/S0896-6273(24)00055-2?_returnURL=https://linkinghub.elsevier.c

Vidcast:  https://www.instagram.com/p/C4gS3KPLeVF/ Using a clever DNA barcoding selection system, bioengineers and immunologists at the University of Pennsylvania have identified lipid nanoparticles or LNPs that selectively accumulate in the lungs.  These molecules than become ideal transport mechanisms for delivery of mRNA to lung tissues.  Such mRNA can be specifically created to trigger the production of therapeutic agents to treat lung diseases including cancer. These lipid nanoparticle mRNA transporters may be familiar to you as they have already been used in the creation of CoVid mRNA vaccines.  The CoVid vaccine lipid nanoparticles as a group are non-specific in their targeting.  These new LNPs may see far more broad deployment for not only vaccines but as carriers for other molecules to other organs as the scope of precision and guided therapy expands. https://www.nature.com/articles/s41467-024-45422-9 #lnp #lipids #nanomedicine #lung #mRNA #vaccines

Vidcast:  https://www.instagram.com/p/C4gR-gkrLco/ Small biopsies of a patient’s pancreatic cancer can be grown out into a 3D cell matrix that provides an advanced look at how effective any given chemotherapy might be inside the human body.  Researchers at La Jolla California’s Salk Institute now report the optimal method for rapidly growing these organoids. The harvested cancer cells grow in liquid nutrient but require a supporting biological scaffold in order to organize themselves into a living testing organoid.  The Salk biologists tested 3 different biological matrix products to determine which generated organoids most reliably. Testing with human tumor but also mouse tumor tissue determined that Matrigel surpassed two other products in successfully promoting organoid development with the smallest numbers of seed cells at the greatest rate of speed. Organoids promise to be important tools in therapy selection.  They join genetic analysis of tumors as indispensable components of precision cancer ther

Vidcast:  https://www.instagram.com/p/C4gQ6IVr85r/ Women monitored with magnetic resonance imaging following initial treatment for BRCA1 positive breast cancer enjoy a 3.5-fold lower risk of mortality compared with those not monitored with such imaging.   This the conclusion of a multisite collaborative study by the Hereditary Breast Cancer Clinical Study Group.   The study reviewed the cases of 2488 women with a BRCA1 sequence variation breast cancer followed for up to 24 years.  Of that number, 1756 women had at least 1 screening MR imaging exam and a mean number of 4.7 over their follow up period.  The women in the MR group developed 241 recurrent cancers leading to 14 deaths or 5.8% mortality rate.   Among the 732 women who did not receive MR surveillance, 103 breast cancers developed leading to 21 deaths with a mortality rate of 20.3% or 3.5 fold higher mortality rate. This is the largest prospective study of MR imaging surveillance for breast cancer, but it does not specifically compare MR with othe

Vidcast:  https://www.instagram.com/p/C4gQIISLcq2/ A new method for rapidly identifying bacteria, fungi, and other microbes is here thanks to a database that catalogues the molecules characteristically produced by these germs, that is their chemical fingerprints.  This tool, named microbeMASST, with MASST standing for mass spectroscopy search tool, has been developed by UC-San Diego pharmacologists. Here’s how it works. Biological samples are fed into a mass spectrometer that can identify the individual molecules.  The list of these substances is then fed into microbeMASST, and the program spits out the names of those microbes that produce such chemicals.  All this in a fraction of the time it might typical take to identify pathologic agents, particularly slow growing ones such as the tuberculosis bacterium. The database now covers in excess of 60,000 microbes and that number will surely grow.  In addition to microbe identification, the database can better help us understand the metabolism of these pathog

https://www.instagram.com/p/C4gPLBTLnTz/ Urinary tract infections trigger a local nerve overgrowth that plagues patients with continuing pain.  A multi-disciplinary team of Duke University pathologists and immunobiologists report this discovery after their clinical and mouse model studies. Beginning with a study of patients with recurrent urinary tract infections, they found that bacterial growth in the urinary system elevates levels of a neuropeptide nerve growth factor that in turn triggers pain nerve proliferation and persisting zombie pain.   The nerve growth factor is a byproduct of immune reactions against the bacteria by both mast cells and monocytes. In a animal model, the investigators were able to suppress this nerve overgrowth with the addition of a nerve growth factor inhibitor. This type of medication may well help future victims of recurrent urinary tract infections prevent development of this zombie pain syndrome. https://www.science.org/doi/10.1126/sciimmunol.adi5578 #uti #urinarytractin

Vidcast:  https://www.facebook.com/watch/?v=955970275479680&ref=sharing The CDC has erased the current 5 day quarantine rule that applies after you test positive for CoVid.  It now says that you can go out in public as soon as 24 hours after diagnosis as long has you have no or improving symptoms and no fever over that 24 hour time.   Actually, the new CDC rules apply to anyone with any respiratory infection including CoVid, the flu, RSV, and even the common cold.  The reason I say any respiratory infection is that only in the case of CoVid do we have a readily available, reasonably priced home test to determine whether or not you have CoVid.  Oh yes there is Lucira, a Pfizer test for both CoVid and influenza, but that will set you back $40 on Amazon for a single test.  That’s 7-8 times as expensive as the $5-6 for each CoVid test. Back to the guidelines.  Besides the 24 hour rule with no symptoms or improving symptoms and no fever off any fever-reducing medications such as Tylenol, acetaminophen, Adv

Vidcast:  https://www.instagram.com/p/C4gMqTirith/ No surprise, but the CDC now announces the appearance of a new CoVid variant.  BA.2.87.1 has just surfaced having infected 9 persons in the Republic of South Africa.  So far, there are no cases of BA.2.87.1 in the US or outside of South Africa, and, for that matter, no significant bump in Covid within South Africa.   That suggests this new variant is not highly transmissible. That having been said, BA.2.87.1 does sport 30 unique mutations in its spike protein always raising the possibility of its escape from the CoVid immunity each of us has built up with vaccinations and infections.  The good news is that most of the recent variants that appeared have been vulnerable to that very immunity. The CDC is closely monitoring this latest CoVid version using case, hospitalization, and wastewater data.  We don’t yet know if this variant will be clinically important.  If it is…remember you heard about it here first.  Stay tuned…. https://www.cdc.gov/ncird/whats-n

Vidcast:  https://www.instagram.com/p/C4MBiAYLxft/ Soliton Inc., an Abbvie company, is touting its non-surgical therapy for cellulite called Resonic.  The device delivers high frequency pulses to affected skin that effectively break up fibrous bands beneath the surface eliminating the mottled, orange rind-like skin that is cellulite.   The company reminds us that 90% of women develop cellulite over time. Problem is that the normally springy bands that traverse the fatty space between skin and underlying muscle harden with aging leading to the puckering characteristic of cellulite.   The company studied 56 women with moderate to severe cellulite treated with the device once.   Pre-and post-treatment photos were evaluated 3 months later by observers who were unaware of which women received Resonic therapy. The data revealed subjective improvement in 91% of treated skin locations.  Skin laxity was improved in two-thirds of treated zones. Resonic therapy requires no anesthesia and is non-invasive.  The vibr

Vidcast:  https://www.instagram.com/p/C4MAXiKLe0p/ There is a nasal antiseptic preparation called Nozin Nasal Sanitizer being touted on TikTok,Twitter, and Facebook as an effective nasal antiseptic against not only bacteria such as Staph aureus but also CoVid and other viruses.  On February 6, 2024, the FDA fired off a warning letter to the company manufacturing Nozin warning it to cease and desist advertising the product as it is an unapproved new drug with multiple misbranding violations. This product is a compound with 62% alcohol as the active ingredient designed to be swabbed on the outer portion of the nostril with included swabs or directly with a applicator-dispenser. The product claims universal sustained nasal decolonization without antibiotics, iodine, or a prescription. Because the claims made for this product categorize it as a drug, it cannot be marketed without an FDA review of data proving its safety and effectiveness.  This has never occurred. As a practical matter, the product is design

Vidcast:  https://www.instagram.com/p/C4L_nzTLCia/ The FDA warns the public that there is no approved wearable device, no smartwatch and no smart ring, that can capably measure or control blood sugar levels on its own.  The agency contrasts this situation with watch and phone applications that work with skin-piercing sensors such as Libre, and Dexcom. Manufacturers of these freestanding watch and ring wearables have not submitted verified data for FDA review in order to prove that these devices can accurately measure blood sugar. https://www.fda.gov/medical-devices/safety-communications/do-not-use-smartwatches-or-smart-rings-measure-blood-glucose-levels-fda-safety-communication #wearables #glucose #smartwatches #rings #fda #warning

Vidcast:  https://www.instagram.com/p/C4L-mmcrixL/ Injecting a herd of a patient’s own white cells known to kill that patient’s malignant skin cancer is effective court-of-last-resort therapy for advanced melanoma resistant to other treatments.  A multi-site study of 153 with such tumors showed that this treatment known as TIL or Tumor Infiltrating Lymphocytes induced significant tumor regression in 31% of patients, complete elimination of detectable tumor in 5%, and continuing tumor control at 18 months in 42%. In response to these exciting results, the FDA has approved the use of this therapy, marketed as Amtagvi with lifileucel as the generic by Iovance Biotherapeutics,  Amtagvi is not a drug but rather a process.  A patient’s persistent or recurrent melanoma is surgically excised and so-called tumor infiltrating lymphocytes or TILs are harvested from the tumor.  These immune T lymphocytes are then grown outside the body into a battalion uniquely capable of killing that patient’s tumor.  The patient rec

Vidcast:  https://www.instagram.com/p/C4L93kbrvEV/ A 15 minute exposure to red light can lower blood glucose levels by nearly 28%.  This the finding by investigators at University College London following their study of 15 healthy adults in light treatment and control groups.  Both groups of participants were given sugar doses prior to serial measurements of their blood sugar.  The light appears to stimulate cell mitochondrial activity which leads to enhanced sugar utilization.   This finding in adults without diabetes raises that possibility that light may be yet another tool for the management of diabetes. Many more studies are needed, but the 670 nm red light used to treat acne, scars, and aging skin may help provide better treatment if not elimination of diabetes…….someday soon. https://onlinelibrary.wiley.com/doi/10.1002/jbio.202300521 #red #light #sugar #mitochondria #diabetes 

Vidcast:  https://www.instagram.com/p/C4L8irNrMGq/ Eating a diet rich in healthy plant-based foods or a pure vegetarian diet is associated with a 16-20% improvement in breath-holding during sleep.  On the other hand, wolfing down unhealthy plant-associated offerings led to a 22% sleep apnea exacerbation.   These are the overall conclusions by Australian investigators reviewing dietary and sleep quality data from 14,210 participants in that nation’s National Health and Nutrition Examination Survey.  That data revealed that women saw a greater benefit from healthy eating enjoying a 33% apnea improvement versus only a 10% improvement in men.  However, the ladies eating unhealthy plant based food  fared worse than the men with 42% worse apnea versus only 13%. Healthy plant-based foods included whole grains, fruits, vegetables, nuts, beans, tea and coffee.  Non-healthy plant-based foods were refined grains, potatoes, sugar-sweetened beverages, sweets and desserts, salty foods.   How healthy you eat during the