The 2 Minute Medicine Podcast Episode 17

Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians. On this podcast, twice a month, we cover the latest in healthcare news and research evidence.

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[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians.

[Deepti] Welcome to the 2 Minute Medicine Podcast, summarizing the latest medical studies, curated and written by practicing physicians.

For our full suite of daily medical study summaries and updates written by practicing doctors, please visit our website at 2minutemedicine.com to start reading new daily content right now, for free. On this podcast, twice a month, we cover the latest in health care news and research evidence. We are your hosts Deepti and Andrew. On today’s episode, we’ll start off by discussing our two articles of the week. In the second half of the episode, we will look at health issues that have arisen in popular media. 

[Andrew] Our article of the week comes from the New England Journal of Medicine and is entitled “Phase 3 Trial of Epicutaneous Immunotherapy in Toddlers with Peanut Allergy“.

Since the turn of the century, the incidence and prevalence of peanut allergies among children have increased dramatically. Notably, it is a common trigger of severe allergic reactions that can continue into adulthood. Although ongoing research is being done, no approved treatment options exist for children younger than four years old.

This large, international, double-blind, randomized controlled trial involving fifty-one centers across four countries evaluated the efficacy and safety of epicutaneous immunotherapy patches for peanut allergies in children aged one to three years old. The primary outcome of interest was the difference in the proportion of participants between the control and intervention arm who met the baseline eliciting dose of more than 10 mg of peanut protein and the post-treatment eliciting dose of at least 1000 mg. Additional outcome measures of interest included the rate of adverse events and the change from baseline to 12 months after the intervention in cumulative reactive and eliciting doses between the two groups. Participants were excluded if they had a history of severe anaphylaxis to peanuts requiring intubation, ventilation, or inotropic support.

Overall, 362 participants were randomized in a 2:1 ratio to receive the epicutaneous peanut patch (n=244) or placebo (n=118). Preliminary results of the study found that participants in the intervention group were significantly more likely to meet the primary endpoint than those in the placebo group (risk difference, 33.4%; 95% Confidence Interval, 22.4-44.5; p<0.001). Treatment-related anaphylaxis occurred in 1.6% of the intervention group and 0% of the placebo group. In summary, the present study demonstrated that this epicutaneous immunotherapy patch was more effective than a placebo at desensitizing children with allergies to peanuts. It generally had an acceptable safety profile but had a higher incidence of treatment-related anaphylaxis compared to the placebo group. Notably, the results of this study cannot be generalized to those with known severe anaphylactic allergies to peanuts. Further, the majority of the patients included were White or Asian, limiting the generalizability of this study to children of other racial backgrounds.

[Andrew] Now for the Scan by 2 Minute Medicine®,  a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers. We wills tart off by talking about antibiotic resistance. 

The Story: The battle against bacteria is a difficult one, wrought with difficulty as these organisms rapidly develop resistance to conventional antibiotics. To fight this antibiotic resistance, a team from McMaster University decided to leverage a powerful tool in their arsenal of antibiotic discovery, artificial intelligence.

Humans are inconceivably outnumbered by bacteria, but fortunately, there is a defense! Antibiotics are specialized compounds that are used for their ability to stop bacterial growth. Since bacteria are such rapidly growing organisms, they are able to quickly develop resistance to antibiotics, making diseases harder to treat and more deadly. The CDC has designated antibiotic resistance as a major threat to human health, with an estimated 4.95 million deaths associated with these resistant bacteria. Why might that be?

It is because in the case of an infection brought on by a resistant strain of bacteria, finding an antibiotic becomes a difficult task. Such is the case of Acinetobacter baumannii, a microbe which is resistant to multiple different antibiotics. It is precisely this resistance which makes Acinetobacter baumannii infections so difficult to treat. 

[Deepti] That’s right! Antibiotic resistance is leading to increased mortality, and higher costs worldwide. A research group from McMaster University has used artificial intelligence to develop a novel antibiotic, called abaucin. To read more about this, please check out the Scan. To prevent bacteria from becoming resistant, one important intervention is to follow the instructions prescribed by a clinician when prescribing antibiotics. While patients continue to follow those instructions, we will look towards researchers and artificial intelligence for potential solutions to this conundrum of antibiotic resistance.

Now let’s take a closer look how Melissa Gilbert, known for her role in “Little House on the Prairie”, experienced a bug bite which led to an emergency room visit and overnight hospitalization!

[Andrew] Gilbert was diagnosed with cellulitis, a bacterial infection of the deeper layers of the skin. Cellulitis is often accompanied by pain, warmth, and redness, and is treated using antibiotics. In order to minimize one’s risk of cellulitis, it is important to avoid wounds to the skin. Unfortunately, during the summer, insects are in full force, and insect bites are virtually unavoidable. In this case, cleaning any bug bites or skin injuries with soap and water, as well as an antibiotic ointment will help to minimize cellulitis risk. Luckily, in Melissa Gilbert’s case, a night of antibiotics and ER care has set her on course toward what we hope is a speedy and full recovery.

Although it may seem similar, this extreme reaction is drastically different from the normal physiological response to insect bites. While we don’t know what kind of insect bit Gilbert, we do know that these summer months are when ticks emerge and start to bite. Given the importance of being outside during the summer months, it is important to stay safe from ticks and tick-borne diseases – and there are several types to keep an eye out for!

[Deepti] One example is Lyme disease, a disease experienced by up to 476,000 Americans each year. Senator Chuck Schumer has recently announced a “War on Ticks”, consisting of $160 million to ensure the eventual eradication of tick-related diseases like Lyme disease, which will look to educate the public and fund research to put an end to these preventable tick-related diseases.

Next, let’s discuss how in an unprecedented move, Canada is now requiring health warnings to be printed on individual cigarettes. Warnings were printed on the packaging of cigarettes, but now each individual cigarette will carry a stark warning to consumers about the risks of smoking. The idea behind this new rule, is to help reduce nationwide tobacco use to under 5% by 2035.

Now it is very difficult to deny that smoking is very detrimental to one’s health, so why is it still an issue? Part of the reason is that chronic cigarette use creates an addiction. In fact, there is evidence that industry-sponsored warnings do not stimulate smoking cessation, likely due to the addictive potential of nicotine, a constituent of cigarettes. Nicotine binds to various brain regions to stimulate the release of neurotransmitters, such as dopamine. Dopamine is a neurotransmitter that plays a vital role in signalling pleasure or rewards. Because of this, when nicotine induces a release of dopamine, it is perceived as a rush of pleasure in the brain. At that point, if someone decides to quit, they may encounter a constellation of negative symptoms, known as nicotine withdrawal, in part due to the immediate removal of dopamine.

[Andrew] Given the long list of conditions for which smoking is a known risk factor, it is of paramount importance that smoking cessation is initiated when possible. Treatments to assist with smoking cessation include nicotine replacement therapies, such as nicotine gum or patches, as well as medications to help mitigate the effects of withdrawal, and allow for effective smoking cessation. Many celebrities, including former US President Barack Obama, have leveraged these treatments to make smoking cessation more effective.

Canada isn’t the only country focusing on reducing smoking rates. As part of their anti-smoking campaign, New Zealand has outlined new rules to curb smoking in their youth. This includes a ban on disposable vapes, due to the increased prevalence in youth using vapes in New Zealand. Next, let’s revisit a topic we had discussed in a previous episode of our podcast, Damar Hamlin’s life saving on-field CPR and the importance of raising awareness about CPR and the use of AED’s.

[Deepti] After Damar Hamlin’s life was saved following on-field CPR, the entire football world has been cognizant of the importance of CPR. Los Angeles Rams’ defensive coordinator Raheem Morris certainly paid attention, as he rushed to find an AED when he was confronted with a three-year old who had been drowning in a pool. Morris was able to locate an AED and assist a doctor on scene, which ultimately resulted in the child being discharged from the hospital a day later.

An AED is an automated external defibrillator, with the main advantage of an AED being that it can be used effectively by bystanders with little to no formal medical training. This is because many AEDs are equipped with voice commands, which tell the bystander what buttons to press to initiate the required responses. And its not just football, sudden cardiac events are present in many sports. During a recreational hockey game in late March, Brandon Miller experienced a frightening cardiac incident which left him unconscious on the ice. One of the players was a physician, and with the help of others, they were able to begin CPR on Miller, until he was eventually transported to the hospital and treated.

[Andrew] That’s right. Also, June 12th represents 2 years following Christian Eriksen’s on-field cardiac arrest at the Euro 2020 cup. He received on-field CPR and was brought to the hospital, where he recovered enough to continue playing professional soccer, which he continues today.

After his incident, Damar Hamlin has embarked on a tour to raise awareness for CPR, highlighting the importance of CPR in sports. This tour begins in Buffalo, with stops in cities across the USA, where Hamlin will be distributing AEDs to sports teams, and youth groups. In partnership with his organization, the Chasing M’s Foundation, Hamlin has distributed over 50 AEDs to sports teams and community groups in Buffalo, and is now moving forward to other cities to raise awareness for CPR, and contribute to equipping groups with tools needed to ensure safety of youth.

We’d like to acknowledge the following members of our team for their contributions to this week’s episode

• Neerav Mullur
• Grace Yin 
• Kiera Liblik

Thank you for joining us today for this episode of the 2 Minute Medicine Podcast. New episodes come out every other week and all of our content has been curated and written by practicing physicians.

Please head to our website at 2minutemedicine.com to learn more and to access all of our content including medical study summaries, visual abstracts, excerpts from our Classics book series which is available on Amazon, and The Scan, which is our medical newsletter.

Thank you so much once again. To make sure that you don’t miss any of our content please subscribe and follow us on Twitter or Instagram @2MinMed

©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.