Hopkins Med News Update

NEWS STORIES IN THIS ISSUE:

- Johns Hopkins Medicine Celebrates Its Contributions to Keto Therapy as Diet Turns 100
- COVID-19 News: Can Dietary Supplements Help the Immune System Fight Coronavirus Infection?
- Johns Hopkins Medicine Helps Develop Physician Training to Prevent Gun Injuries, Deaths
- COVID-19 News: Study Says Pandemic Impaired Reporting of Infectious Diseases
- Johns Hopkins Medicine Helps Create Treatment Guide for Neurodegenerative Disorders
- Johns Hopkins Pediatrics Says, ‘Get Kids Required Vaccines Before Going Back to School’

JOHNS HOPKINS MEDICINE CELEBRATES ITS CONTRIBUTIONS TO KETO THERAPY AS DIET TURNS 100

On July 27, 2021, the ketogenic diet will turn 100 years old. While the diet was first proposed and studied at the Mayo Clinic, Johns Hopkins Medicine has been a long-standing and pioneering contributor during the past century to the research, application and testing of the diet’s successful use in treating diseases.

The classic ketogenic diet, involving the consumption of high-fat foods and very few carbohydrates, is one of the oldest treatments for epilepsy and was the first diet of its kind when proposed a century ago. After decades of disuse, the ketogenic diet therapy became popular again in recent years, and now is used worldwide. In its many medical adaptations — including the modified Atkins diet, the modified ketogenic diet and the medium chain triglyceride oil diet — the treatment also benefits patients with other conditions, such as pre-diabetes and diabetes, dementia, headaches and some forms of cancer. 

Johns Hopkins is home to the Pediatric Ketogenic Diet Center and the Adult Epilepsy Diet Center. The pediatric epilepsy team at Johns Hopkins Children’s Center has used the ketogenic diet to address seizures since the diet’s therapeutic origins in the 1920s. The Pediatric Ketogenic Diet Center is one of the world’s leading centers for clinical and research expertise on the ketogenic diet, having treated more than 1,500 children with this approach. The Johns Hopkins Adult Epilepsy Diet Center, which opened in 2010, was the first clinic to offer ketogenic diet therapy specially designed for adults with epilepsy. The center has treated over 400 patients with both the classic ketogenic diet and, more recently, the modified Atkins diet.

Johns Hopkins Medicine researchers have published more than 200 peer-reviewed journal articles on the ketogenic diet since the 1930s.

Available for interviews are Eric Kossoff, M.D., professor of neurology and pediatrics at the Johns Hopkins University School of Medicine and medical director of the pediatric ketogenic diet program at Johns Hopkins Children’s Center, and Mackenzie Cervenka, M.D., associate professor of neurology at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Adult Epilepsy Diet Center and the Johns Hopkins adult epilepsy monitoring unit. Johns Hopkins Medicine dieticians also are available for interviews.

Additional websites showcasing Johns Hopkins Medicine’s tremendous impact on ketogenic diet therapy include:

• A timeline graphic portraying the historical connections between Johns Hopkins Medicine and keto diet therapy; and
  
  
• The story of a pediatric patient for whom the keto therapy eliminated seizures from her life.

COVID-19 NEWS: CAN DIETARY SUPPLEMENTS HELP THE IMMUNE SYSTEM FIGHT CORONAVIRUS INFECTION?

Johns Hopkins Medicine gastroenterologist Gerard Mullin, M.D., and a team of co-authors published an article May 11, 2021, in Advances in Experimental Medicine and Biology that details the scientific rationale and possible benefits — as well as possible drawbacks — of several dietary supplements currently in clinical trials related to COVID-19 treatment.

According to business analysts, the U.S. nutritional supplement industry grew as much as 14.5% in 2020, due in large part to the COVID-19 pandemic.

Mullin, associate professor of medicine at the Johns Hopkins University School of Medicine, and his colleagues shine a light on melatonin, vitamin C, vitamin D, zinc and several plant-based compounds, such as green tea and curcumin. For instance, the authors explain that ascorbic acid — also known as vitamin C — “contributes to immune defense by supporting cell functions of both the innate and adaptive immune systems.”

In the journal article, they discuss the mechanics of how each of the supplements works and how each might benefit a patient fighting COVID-19.

Zinc, they write, has been shown “to inhibit coronavirus RNA replication.” They also note that, when administered at symptom onset, zinc “can reduce the duration of symptoms from illness attributed to more innocuous coronavirus infections, such as the common cold.”

Finally, Mullin and his colleagues provide short explanations of the clinical trials underway to test each supplement’s effectiveness in fighting COVID-19.

For example, Mullin says that, “to date, there are abundant data associating low vitamin D status to higher vulnerability to COVID-19 and poor clinical outcomes.”

The authors caution that “any benefit of dietary supplements against COVID-19 depends on results of randomized controlled trials” and peer-reviewed literature.

Mullin is available for interviews.

JOHNS HOPKINS MEDICINE HELPS DEVELOP PHYSICIAN TRAINING TO PREVENT GUN INJURIES, DEATHS

Each year, nearly 40,000 people in the United States die because of guns, making firearm-related injuries a leading cause of death for adults and children. According to a recent report, gun violence surged during the COVID-19 pandemic, making 2020 one of the nation’s deadliest years for firearm-related casualties on record. Health care professionals could help reduce the toll, but only about 20% receive any education on firearm injuries or their prevention. To help change that, Johns Hopkins Medicine experts and collaborators across the United States established a national consensus guideline on educational priorities regarding firearm injury prevention for health care professionals.

The guideline appeared July 6, 2021, in the journal Academic Medicine.

“In many cases, physicians haven’t felt comfortable talking about firearms with patients because it’s been viewed as a divisive subject,” says Katherine Hoops, M.D., M.P.H., assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.

“We set out to change that by being the first to create standards for undergraduate, graduate and continuing medical education, so clinicians and educators have a foundation from which they can develop educational programming for their learners,” says Hoops, who cares for patients — including those with gun-related injuries — in the pediatric intensive care unit at Johns Hopkins Children’s Center.

In April 2019, Hoops and Jahan Fahimi, M.D., M.P.H., an associate professor of emergency medicine at the University of California, San Francisco, convened a diverse group of more than 30 subject matter experts in medicine, nursing and public health from academic institutions across the United States to create a comprehensive and adaptable framework for firearm injury education.

The group outlined six categories previously identified in medical research as priorities. These include a general category with priorities applicable to all types of gun-related injuries and five specific categories focused on intimate partner violence, peer violence, mass violence, suicide and unintentional injury. 

According to the researchers, training based on the new standards should enable clinicians to describe fatal and nonfatal firearm injury epidemiology; understand firearm access, possession, ownership, transfer and use; and be familiar with basic types of firearms and ammunition. They also should be able to provide counseling about firearm injury prevention — such as safe gun storage — to their patients.

Regarding suicide and suicide prevention, the researchers say clinicians should be able to describe the epidemiology of suicide and suicide attempts relating to firearm injury and death, as well as have the ability to assess patient suicide risk and understand how to escalate concerns for patients who may be at risk.

The published paper includes more guidelines and can serve as a resource for educators in health care professional schools.

“We hope that this educational framework will fundamentally change how physicians talk about violence in their practices,” Fahimi says. “It’s engaging with patients, talking about their experiences, helping them understand the risk of injury, and ultimately preventing injuries and saving lives.”

Along with Hoops and Fahimi, Megan Ranney, M.D., M.P.H., of Brown University was a key researcher on this project.

Hoops is available for interviews.

COVID-19 NEWS: STUDY SAYS PANDEMIC IMPAIRED REPORTING OF INFECTIOUS DISEASES

With the health care community heavily focused on COVID-19 since the first quarter of 2020, there have been concerns that reporting of other infectious diseases — and the resulting data that enables them to be more effectively treated and controlled — may have been impacted.

Researchers at Johns Hopkins Medicine and the University of Southern California analyzed the number of reported cases of 42 infectious diseases at the state and national levels between March 2020 and March 2021, compared with those recorded over the previous five years. Their findings were reported online June 7, 2021, in the journal Clinical Infectious Diseases.

The researchers looked for reporting differences by geographic location and by five routes of transmission: sexual, foodborne/waterborne, vectorborne (such as mosquito transmission), injection drug-use associated and respiratory.

Among the study’s highlights was a nationwide 82% drop in the number of cases of mumps reported in 2020, compared with the previous year. Between the same dates, the number of reported cases of chlamydia in the United States fell almost 15%, from 1.57 million to 1.34 million.

“We found substantial differences in the reporting of diseases between 2019 and 2020 by route of transmission, with the greatest relative decrease — nearly 51% — seen for respiratory diseases,” says Matthew Crane, a medical student at the Johns Hopkins University School of Medicine and the study’s lead author. “There also were significant decreases for drug use-associated diseases [47%], vector-borne diseases [44%] and foodborne/waterborne diseases [40%].”

Regarding reporting variation by geographic location, Crane says he and his colleagues found decreases of 50% or greater in 2020 relative to 2019 in five states: Hawaii (75%), Kentucky (66%), Nebraska (65%), Missouri (59%) and North Dakota (55%). Five other states had decreases between 40% and 49%, three states were between 30% and 39%, and seven states were between 20% and 29%. There were decreases in reporting of infectious diseases in 34 states during the pandemic compared with the 2015–2019 period.

“Overall, we found decreased reporting of almost all nationally notifiable infectious diseases and conditions during the COVID-19 pandemic,” Crane says. “These decreases were found nationwide and at the state level, and appeared in all of the disease transmission routes we studied.”

Crane says it’s unknown whether the observed decreases indicate true reductions in infectious disease cases or an impairment of typical disease reporting during the pandemic.

“We believe that both factors likely contributed to our findings,” he says.

Based on these findings — and similar results in an earlier study looking at pandemic-driven reporting variations for sexually transmitted infections — the researchers feel there is a critical need for more investment in disease surveillance in order to understand whether infectious disease transmission may have been underreported during the COVID-19 pandemic.

Crane is available for interviews.

JOHNS HOPKINS MEDICINE HELPS CREATE TREATMENT GUIDE FOR NEURODEGENERATIVE DISORDERS

Some people may think nothing can be done for neurodegenerative disorders such as progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). However, a Johns Hopkins Medicine researcher and his colleagues are adamant that is not the case.

PSP is a rare brain disorder that causes serious problems with walking, balance and eye movements, and later with swallowing. CBS is a condition that causes changes in movement, language skills or both. Both are characterized by deposition in the brain of abnormal, malfunctioning proteins known as tau proteins. These usually show up in people of mid-60s age, leading to death after an average of seven years. 

In a study published July 1, 2021, in the journal Frontiers in Neurology, Alexander Pantelyat, M.D., assistant professor of neurology at the Johns Hopkins University School of Medicine, and 35 colleagues at the non-profit organization CurePSP, outline best practices in the management of these difficult-to-treat disorders. Pantelyat is the study’s joint first author and a member of the four-person steering committee that oversaw the project’s completion.

“There is still a lingering impression that nothing can be done for these conditions and I hope that this comprehensive review can do a lot to dispel this notion,” says Pantelyat, director of the Johns Hopkins Atypical Parkinsonism Center/CurePSP Center of Care. “Time is really of the essence with these conditions and it’s important to understand that much can be done to improve a patient’s quality of life.”

Pantelyat says most physicians, including many neurologists, are reluctant to care for patients with these conditions because they are unfamiliar with the wide range of interacting symptoms and neurological deficits (abnormal functioning, such as the inability to speak). While there currently is no specific or disease-modifying treatment for either PSP and CBS, their symptoms are amenable to a variety of treatment strategies.

Pantelyat says several pharmacological and nonpharmacological interventions can meaningfully improve quality of life for patients with PSP and CBS. With a lack of approved pharmaceuticals for these conditions, the guidelines recommend useful off-brand medications to physicians and clinicians.

“One aspect that the guidelines discuss is avoiding medications that can worsen cognitive function, since in some ways, these diseases are closer to Alzheimer’s disease than Parkinson’s disease,” says Pantelyat.

“In the case of CBS, it’s like having a severe stroke except that it happens over months to years,” he explains. “We encourage physicians to refer patients to a CurePSP Center of Care as soon as possible, enabling them to take advantage of resources like physical therapy, occupational therapy and speech-language pathology that can improve their daily function.”

Pantelyat says the guidelines also address the use of botulinum toxin injections. For patients with excessive saliva, an injection of botulinum toxin can alleviate drooling, and it may improve symptoms for those with dystonia and pain. Since it’s injectable, botulinum toxin doesn’t have systemic side effects.

“We hope this comprehensive guide helps physicians identify patients as early as possible so they can get the appropriate care, and refer them appropriately,” Pantelyat says.

Pantelyat and his colleagues hope to next look at how multidisciplinary care can be delivered remotely to patients with PSP and CBS using a virtual environment.

Pantelyat is available for interviews. 

JOHNS HOPKINS PEDIATRICS SAYS, ‘GET KIDS REQUIRED VACCINES BEFORE GOING BACK TO SCHOOL’

Children and teens will go back to school in a few weeks and many schools will require students to be up to date on their routine immunizations. Johns Hopkins Children’s Center (JHCC) experts recommend vaccinating your child as soon as possible to avoid the last-minute rush before classes start.

“Preparing for the new school year is a busy time, and many parents might wait to schedule immunization appointments until close to the start of classes,” says Kate Connor, M.D., M.S.P.H., pediatrician and medical director of the Rales Center for the Integration of Health and Education at the Children’s Center. “But getting kids the necessary vaccines should be a top priority to ensure they have the protection they need and can return to school on time.”

Each state decides which vaccines are required to attend daycare or school. Children may need vaccinations for illnesses such as chickenpox, measles, mumps, rubella and polio, and teens may require DPT (diphtheria/tetanus/pertussis) and meningitis vaccines. Children and teens can get vaccines at their pediatrician’s office, or in most states, at a local pharmacy if the child is at least eight years old. Some locations require appointments in advance.

“Parents may have delayed routine care for their healthy children during the pandemic,” says Connor. “So, it’s important they confirm with their child’s pediatrician that immunizations are up-to-date and that other needed preventive care is done before the start of school.”

This year, for children age 12 and older, JHCC experts also recommend the COVID-19 vaccine, even if it isn’t required for your child’s school. “We’ve seen the devastating effects of COVID-19 for more than a year now, and getting your kids the COVID-19 vaccine as soon as they are able is an essential part of preventing serious illness,” says Nakiya Showell, M.D., M.P.H., M.H.S., pediatrician and medical director of JHCC’s Harriet Lane Clinic.

To find out which vaccines are necessary, JHCC experts suggest talking with your  pediatrician, checking with administrators at your child’s school or daycare facility, or visiting the U.S. Centers for Disease Control and Prevention's vaccination website.

Connor and Showell are available for interviews.

National Immunization Awareness Month is in August.