Bariatric

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COVID Reinfection; Bariatric Surgery Life Expectancy: It’s TTHealthWatch!

TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week. A transcript of the podcast is below the summary.

This week’s topics include a reinfection with SARS-CoV2, excess death data on the pandemic, the benefits of bariatric surgery, and new strategies for rheumatoid arthritis.

Program notes:

0:44 Rheumatoid arthritis management

1:45 Looked after 12 weeks, 28 joints

2:45 Look at different pathways

2:55 Life expectancy after bariatric surgery

3:55 Three years longer life with surgery

4:56 Very large study

5:55 Deaths observed in other studies

6:10 Excess deaths relative to COVID-19

7:10 A 20% increase compared with expected deaths

8:10 Adopt best practices

9:10 Reinfection in the US

10:11 Isn’t the first case of reinfection

11:10 If you were asymptomatic you could spread

12:10 Could more severe disease be reinfection?

13:07 End

Transcript:

Elizabeth Tracey: Does bariatric surgery improve lifespan?

Rick Lange: Treatment of refractory rheumatoid arthritis.

Elizabeth: A case of frank reinfection with SARS-CoV-2.

Rick: And excess deaths associated with the pandemic of 2020.

Elizabeth: That’s what we’re talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: And I’m Rick Lange, President of the Texas Tech University Health Sciences Center in El Paso, where I’m also Dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, I’m going to let you decide. Do you want to start with the COVID stuff or would you rather do the other stuff first?

Rick: Let’s talk about the other stuff first. How about rheumatoid arthritis?

Elizabeth: Okay. That’s in the New England Journal of Medicine.

Rick: As you’re aware, and most of our listeners aware, rheumatoid arthritis is an inflammatory disease, a process that attacks the joints, and multiple joints throughout the body. The mainstay of treatment was what is known as DMARDS, or disease-modifying antirheumatic drugs. But despite these, some individuals continue to have a debilitating rheumatoid arthritis.

What investigators have done is try to identify different pathways that can affect the immune system, either to suppress it or modulate it. Two such pathways are called the Janus kinase pathway — and we now have access to an oral Janus kinase inhibitor called upadacitinib — and a separate pathway that affects T cells, called T-cell costimulator, and that’s abatacept. Is one better than the other? That’s what these authors attempted to examine.

They took over 600 patients that had been on a biologic DMARD, but it wasn’t successful, so they kept them on this synthetic DMARD and then added either the oral inhibitor or the IV abatacept. They evaluated them after 12 weeks and used what was known as the disease activity score. They looked at 28 different joints, and

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