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TWiM 24 Letters

Jayne writes:

Thanks so much for your podcasts. I find I am a person who learns best audibly and have just jumped into the science, history, medical and EMS blogs, I Listen to a podcast called SMART EM by a pair of ED docs, and they covered the issue of UTI in Peds. They do journal and study reviews and the found that there isn't any basis for the idea that untreated UTI causing kidney damage for Peds. I know, I know, but they took the time to ferret out all the info. Anyway, I am enjoying your podcasts. I don't think going back to school is something I can do, but about once a week I go to a class on virology, parasitology and microbiology. The tuition is great. No student loans. No sleeping in class.


Al Sacchetti answered: Jayne is correct and not correct depending on who you read. This is one of those topics that will continue to be debated as it is mostly "soft" science.

It is all based on retrospective case studies so you really can't design what would be considered a good scientific study to prove it. Such a study would involve not treating a cohort of children with urinary tract infections and following them and a second subset of treated children to determine if one group develops more hypertension than the other. Not an ethical study to perform.

The other confounder is that there are multiple other causes of hypertension that may overwhelm the cases caused by infant UTI's.

For me the take home message will not become clear for another two decades. That is how long it will take for this generation of treated children to grow old enough to really look at the epidemiology of their hypertension. (As an aside, it is one of those issues that really will not change our practices since we will always treat a UTI in a child.)

On a different note. What would you think Kamagra Online about doing a TWIV on Hepatitis C with a Hepatitis C Virologist, a Transplant Surgeon, a Hepatologist and possibly a hepatitis C patient? From the Bench to the Bedside type of show.

Take care and continue the great work you do with the all the TW's


Jeff writes:

Hi Guys - I was wondering if you had seen the following article in about the lack of acorns being produced in the Northeast this year. In it they mention that the lack of acorns in the past is associated with crashes in the mouse population, then, the author says: "And because the now-overgrown field mouse population will crash, legions of ticks — some infected with Lyme disease — will be aggressively pursuing new hosts, like humans."

Currently here in Atlanta our oak trees are producing massive quantities of acorns. Every few years oaks will begin producing lots and lots of acorns in a season - a phenomenan thought to saturate their predators and try to increase the odds that ssome of their seedlings will germinate and take root. Is there any way that you could do a show (or part of) on some aspect of this Oak-mouse-tick-Borrelia story? It has the parasites (ecto - tick, endo-Borrelia) angle and it has this beautiful tie in to local ecology. I know it isn't typically what you do on the show, but if you can do some aspect of it that would be great. I am going to use this story in my non-science major introductory biology course next semester for some active learning in the classroom, and being able have my students listen to another TWIP/M/V podcast as preparation for those classroom sessions would be too perfect. Does Dr Gwadz have an expertise on the ecology of lyme disease maybe?

Thank you for the great shows, keep up the great work!


Georgia Perimeter College

Here is the link:

Here is an article in American Scientist which passes for a pretty good review on the subject:


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