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UrduWe also want you to continue having access to the latest Johns Hopkins Medicine research achievements and clinical advances, so we issue a second tip sheet covering topics not related to COVID-19 or the SARS-CoV-2 virus. “Research News Tip Sheet: Story Ideas from Johns Hopkins Medicine” alternates Wednesdays with the COVID-19 Tip Sheet.
Stories in this tip sheet associated with journal publications provide a link to the paper. Interviews may be arranged by contacting the media representatives listed.
NEWS STORIES IN THIS ISSUE:
- Johns Hopkins Medicine Team Tests Medical Marijuana as Possible Therapy for Chronic Itch
- Johns Hopkins Medicine Puts Fat to Good Use as Stem Cell Source for Spinal Fusion Surgery
- New Automated Insulin Infusion System May Potentially Reduce Medical Errors, Improve Care
- Teenage Patient Strums a Happier Tune After a Year Dealing with Lupus
JOHNS HOPKINS MEDICINE TEAM TESTS MEDICAL MARIJUANA AS POSSIBLE THERAPY FOR CHRONIC ITCH
Chronic itch — known clinically as chronic pruritus — is characterized as an unrelenting and sometimes even debilitating sensation to itch, and often lowers the quality of life for those who suffer with it. Treating the condition has been difficult because there are few Food and Drug Administration-approved therapies. Now, a recent case study by Johns Hopkins Medicine researchers provides evidence that a promising option for patients with chronic itch may already be available: medical marijuana (cannabis).
A report on the team’s findings was published April 9, 2021, in JAMA Dermatology.
“Chronic itch can be an especially difficult condition to treat, with off-label therapeutics often utilized,” says Shawn Kwatra, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine. “With the increased utilization of medical marijuana and our knowledge of the role of the endocannabinoid system [a complex cell-signaling system that regulates a variety of functions in the body] in chronic itch, we decided to try medical marijuana with a patient who failed several therapies and had few options left.”
Kwatra and his colleagues examined an African American woman in her 60s with a 10-year history of chronic itch. The patient initially arrived at the Johns Hopkins Itch Center with complaints of extreme pruritus on her arms, legs and stomach. Upon a skin examination, numerous hyperpigmented, raised skin lesions were revealed. Several treatments were offered to the patient — including several systemic therapies, centrally acting nasal sprays, steroid creams and phototherapy — but they all failed.
Kwatra says that using medical marijuana — either by smoking or in liquid form —provided the woman with nearly instantaneous improvement.
“We had the patient rate her symptoms using a numerical rating scale, where 10 is the worst itch and zero is no itch at all,” Kwatra says. “She started at 10 but dropped to 4 within 10 minutes after initial administration of the medical marijuana. With continued use of the cannabis, the patient’s itch disappeared altogether.”
The researchers believe that one of the active ingredients in medical marijuana, tetrahydrocannabinol — commonly known by its abbreviation THC — attaches itself to brain receptors that influence the nervous system. When this occurs, inflammation and nervous system activity decrease, which also could lead to a reduction in skin sensations such as itchiness.
Kwatra says that although conclusive studies have yet to be done to validate medical marijuana as an effective measure for the relief of previously unmanageable itch, he believes it warrants further clinical trials.
“Controlled studies are needed to determine dosing, efficacy and safety for medical marijuana in the treatment of various human itch subtypes, and once those are performed, we will better understand which patients are most likely to benefit from this therapy,” he says.
Kwatra is available for interviews.
JOHNS HOPKINS MEDICINE PUTS FAT TO GOOD USE AS STEM CELL SOURCE FOR SPINAL FUSION SURGERY
Adipose cells, better known as fat, may be the least popular component of the human body. However, most people don’t realize that fat actually has many important functions in establishing and maintaining good health — providing energy, insulating the body against heat loss and protecting nerves, just to name a few. Now, researchers at Johns Hopkins Medicine suggest there’s another role for the poor maligned adipose cell: a practical and plentiful source of stem cells for use in spinal fusion surgeries.
Spinal fusion, used to correct problems in the spine, is the “welding” together of two or more vertebrae so that they heal into a single, solid bone. Unfortunately, the surgery — using bone taken from other parts of the patient’s body — fails in up to one out of every five procedures. Researchers have found that stem cells, harvested from a patient’s marrow and allowed to mature into bone cells, can yield successful outcomes when used in spinal fusions. However, the aspiration method for extracting stem cells from the marrow carries a risk of infection and often is painful.
In a study published in the May 2021 issue of the journal Spine, Timothy Witham, M.D., director of the Johns Hopkins Neurosurgery Spinal Fusion Laboratory, Alexander Perdomo-Pantoja, M.D., a postdoctoral fellow at the Johns Hopkins University School of Medicine, and Christina Holmes, Ph.D., a former Johns Hopkins Medicine postdoctoral fellow now at Florida State University, worked together with colleagues to try out adipose cells rather than bone marrow as a source for the stem cells.
Performing spinal fusion procedures in rats, the researchers found that freshly isolated stem cells from fat worked just as well as the more commonly used bone marrow stem cells. The researchers say this suggests the technique could be a candidate for human clinical trials.
“Bone marrow stem cells are isolated in human patients from the hip,” says Holmes. “But using a huge needle to take out bone marrow is a painful procedure, and we can only get a limited number of cells, so we’ve found an alternative source by using stem cells from fat.”
Perdomo-Pantoja says spinal fusion procedures are used to treat many different conditions.
“Spinal fusions are used for anything that causes spinal instability, which usually produces significant mechanical pain,” he says. “You see it frequently when we get older as the intervertebral discs, ligaments and muscles in the spine deteriorate. But these procedures can also be used to treat instability when it is caused by tumors, fractures, deformities or trauma.”
In this study, Witham, Perdomo-Pantoja, Holmes and their team isolated stem cells from fat and bone marrow, and then implanted them into rat spines. For the adipose-derived stem cells, the researchers chose to use freshly isolated cells to see if they could make the procedure simpler and faster.
Currently, stem cells from either bone marrow or fat are frequently grown in a laboratory culture to get them mature enough for a spinal fusion. During culturing, there is some risk of contamination or transformation into unusable bone. Holmes says that freshly isolating cells avoids these problems, along with being less labor intensive and cheaper because expensive processing materials are not needed.
While stem cells from fat are commonly used in cosmetic procedures, they are not often used in spinal fusions, she adds.
“We feel that fat cells are a logical alternative to bone marrow cells because most patients have an adequate supply of fat cells,” Witham says. ”Fat also is much more accessible during surgery and can be harvested with less stem cell death than bone marrow. Spinal fusion is a very common procedure, and we feel this approach could be applied across a wide cohort of spinal fusion patients.”
The researchers also were pleased to see the quality of the bone created by both forms of stem cells. They found significantly more bone formation and blood supply in the fresh adipose-derived stem cells compared with what they observed in previous studies with cultured cells from both fat and bone marrow.
Witham and his team hope to further their research by next identifying which cells are the most advantageous for spinal fusions and then characterizing them.
Witham is available for interviews.
New automated insulin infusion system May potentially reduce medical errors, improve care
Nurses traditionally manage insulin intake for critically ill patients by following precise steps to manually calculate the correct dose for each person. Looking for ways to improve this process, researchers at the Johns Hopkins Armstrong Institute for Patient Safety and Quality recently tested a “smart agent” system that integrates electronic health records and infusion pumps to automate insulin dose selection.
The study showed that Smart Agent — developed as a joint effort between the Johns Hopkins University Applied Physics Laboratory and the Johns Hopkins University School of Medicine — may reduce errors and provide faster insulin delivery when compared with manual dosing calculation. In turn, the researchers say, this could free up nurses and clinicians to focus their attention on other patient care priorities.
The findings, published online March 10, 2021, in the journal BMJ Quality & Safety, suggest that a smart agent system could potentially optimize safety and efficiency of insulin infusion practices in intensive care unit settings.
“Glucose management improves outcomes for critically ill patients; however, current insulin infusion protocols are work-intensive for nurses and may be error prone,” says study lead author Michael Rosen, Ph.D., M.A., associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.
The current infusion process requires a nurse to manage insulin doses hourly, based on the patient’s condition. Because neither the patient’s medical record nor the infusion pump’s operating data communicate electronically, a nurse is required to first retrieve the patient’s blood glucose level from the health record. Then, he or she must manually calculate the medication rate change using an algorithm to determine the new insulin dosage. A second nurse double checks this process before it’s documented in the medical record, and finally, the new dose is manually programed into the infusion pump to administer insulin to the patient.
For the study, 20 critical care nurses at The Johns Hopkins Hospital in Baltimore, Maryland, tried a specific smart agent system in a simulation-based setting between May and July 2018. Participants completed 12 mock situations, in four blocks of three scenarios each. Each block was performed with either the manual protocol or Smart Agent.
Nurses were surveyed after each session to get their impressions of safety levels (rates of errors), efficiency (time to complete each task), perceived workload, trust in the system and usability.
The researchers say their findings show that the automated system was significantly better in dosing accuracy calculation compared with manual calculation. In 120 scenarios, nurses never made a calculation error when using the smart agent system compared with 20 errors (16.6%) made using the manual system.
Smart Agent enabled the nurses to complete the process an average of 29 seconds faster than the manual system, along with reducing their overall workload. The tasks that consumed the most time using the manual system were retrieving information from the electronic health record and performing manual calculations — neither of which is required in a smart agent system. The nurses also found that after using Smart Agent at least twice, they trusted it more than doing the manual calculations.
In general, Smart Agent received positive remarks from all 20 nurses. Most found it to be helpful and more efficient than the manual system, and 18 (90%) found it easier to use. Fifteen (75%) nurses believed that the automated system was safer than the manual process, while five (25%) were unsure or believed both systems were about as safe.
“This approach can be applied to improve a fragmented and inefficient health care IT infrastructure through design, testing and system integration,” says senior study author Adam Sapirstein, M.D., associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.
The researchers believe that Smart Agent can serve as a template for similar systems that use algorithms built directly into electronic medical records so that they can be integrated with devices for automatically delivering medication to patients.
This study was done in collaboration with University Hospitals of Cleveland.
Rosen and Sapirstein are available for interviews.
TEENAGE PATIENT STRUMS A HAPPIER TUNE AFTER A YEAR DEALING WITH LUPUS
As a high school student, Ellie Killinger from Middleburg, Virginia, went from playing field hockey and volleyball, serving as class president, acting in musicals, and writing and performing songs to being bedridden.
It all started in December 2018, when Killinger, then a 14-year-old ninth grader, started feeling nauseated all the time. Over the next year, her symptoms progressed to include eyelid swelling, a rash across her cheeks and nose, recurrent mouth sores, fatigue, joint pain and brain fog.
“School was becoming challenging for me, and that was never the case before,” Killinger recalls.
Killinger’s parents took her to several doctors and specialists in the hope of finding a solution to her ailments. Eventually they turned to Johns Hopkins Children’s Center (JHCC) and a team of physicians there, including Ekemini Ogbu, M.B.B.S., M.Sc., director of the Pediatric Lupus Multidisciplinary Clinic and assistant professor of pediatrics at the Johns Hopkins University School of Medicine.
About the same time she first visited JHCC, Killinger developed severe tremors in her body, including her legs and arms. “She had difficulty holding a cup, and couldn’t walk down steps,” says Killinger’s mother, Angela.
In February 2020, Killinger was admitted to JHCC for eight days. During that time, she was diagnosed with systemic lupus erythematosus, a chronic autoimmune disease that causes uncontrolled inflammation and was involving her entire nervous system.
Lupus — which can develop at any age but starts in children in 20% of cases — impacts nearly 1.5 million people in the United States. The American Academy of Pediatrics estimates that some 10,000 of those patients are children. The disease has no known cause and affects many parts of the body in unpredictable patterns, including the joints, skin, and major organs such as the heart, kidneys and brain. Some patients experience mild cases of lupus, while in others, it can be life-threatening.
Pediatric patients tend to have more severe forms of lupus and the disease is more common in girls. Additionally, there is a higher risk of children developing lupus if they are African American, Asian American, Hispanic/Latino, Native American or Pacific Islander, or if there is a family member with lupus or another autoimmune disease.
“The diagnosis of lupus can be challenging, because at present, there is no single test that can do it reliably,” says Ogbu. “Diagnosis is based on the patient’s symptoms, physical examination, and various lab results and tests, which fit together like pieces of a puzzle.”
The treatment for lupus varies from patient to patient and involves managing inflammation with medications and lifestyle changes. In Killinger’s case, her therapy started with some commonly used approaches: biologic therapy, chemotherapy and steroids. Ogbu has varied Killinger’s treatment plan a few times to find the right fit for her, a strategy that is typical for patients with lupus. As Killinger’s condition has improved, her medications have gradually been reduced.
A year after Killinger was diagnosed, the now 17-year-old high school junior feels like she has gotten her lupus under control. While lack of energy keeps Killinger from participating in many of the activities she enjoyed before her diagnosis, she is back to writing and playing music. Killinger even won first place in a local competition for her song, “Sick,” about the search for the cause of her illness
Killinger also has begun a clothing line called #EllieRose Strong, and has used it to raise $9,000 in support of lupus research at JHCC.
“Ellie came in with a rare presentation of lupus that affected her nervous system,” Ogbu says. “She is sharing her experience with her disease to raise awareness about lupus in children. She is so resilient.”
There is no cure for lupus. Patients with the disease can have flare-ups and periods of remission when they experience partial or complete lack of symptoms. Still, Killinger remains hopeful about her future, whether playing musical “gigs” or planning for college, where she hopes to major in clinical psychology with the goal of working with kids who have chronic illnesses.
Killinger often thinks back on the past 2 ½ years without remorse. “There wasn’t a lot of time to feel sad or grieve the things I lost when I was sick,” she says. “It’s so normal for me now, but wow, that was a lot to go through.”
Killinger, her mother and Ogbu are available for interviews.
May is Lupus Awareness Month.
