2017 Starter Pack: Kidney Stones

It’s the beginning of a new academic year – and whether or not you are entering the ED for the first time, or returning after a hiatus it’s a good time to catch up on the basics. That’s what these “Starter Packs” are about. I have collated a number of different posts to give you an idea of what I’ve shared over the past few years on a number of common conditions. This one focuses on kidney stones.


Kidney Stones 01: Presentation

Kidney Stones 02: Labs

Kidney Stones 03: Imaging

Kidney Stones 04: Treatment

A podcast on kidney stones

Mastering Intensive Care 010 with Imogen Mitchell

LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog

Imogen Mitchell – An intensivist and Dean of Medicine focused on communication and clinical decision-making

Do you seek the relative at the bedside’s help by asking them their opinion on whether their loved one is getting better or not? Do you even have families at the bedside on your ward round? Do you listen as much as you can in your end of life discussions?

Professor Imogen Mitchell, a senior intensivist and Dean of Medicine from Canberra, Australia, sees talking to our patient’s families as one of the privileges of working in intensive care. She is a huge supporter of having families at the bedside for the clinical ward rounds and is a passionate believer in exposing our own vulnerability in family meetings, particularly by listening to the patient and their family’s stories first. Imogen has also consistently placed communication with the multi-disciplinary intensive care team at the forefront of great clinical care.

Now as one of the senior women in Australasian Intensive Care, Imogen is also passionate about the gender inequity in intensive care training and also in consultant intensivist positions. She has felt the frustration of being a woman in intensive care when she has noticed behaviours that in retrospect she has wondered whether men would ever have been subjected to. Imogen also struggled to find the perfect mentor earlier in her career, perhaps because of the scarcity of female intensivists at the time. She now wants to make sure young female medical students and intensivists come to understand that intensive care can be an excellent career for both genders.

Imogen is thoughtful, intelligent, compassionate and considerate. She has been a leader for most of her career, making her the ideal person to give us advice on leadership, communication, decision-making, the training of young doctors, and debriefing to manage stress. In this interview, Imogen starts with how she came to fancy intensive care over her initial desire to be a histopathologist, and ends with some great “life” tips for less experienced clinicians.

This podcast was created to help and inspire intensive care clinicians to improve the care we give to our patients by providing interesting and thought-provoking conversations with highly respected and experienced clinicians. In each episode, Andrew Davies, an intensivist from Frankston Hospital in Melbourne, Australia, speaks with a guest for the purpose of hearing their perspectives on the habits and behaviours that they believe are the most important for improving the outcomes of our patients. Things like bringing our best selves to work each day, optimal communication, coping with stress and preventing burn out, working well in a team, and interacting with patient’s families and the many other health professionals we deal with on a daily basis. The podcast is less about the drugs, devices and procedures that can be administered and more about the habits, behaviours and philosophies that can help intensive care clinicians to master the craft of intensive care.

Please send any comments through the Life In The Fast Lane website, facebook (masteringintensivecare), twitter (@andrewdavies66) or by simply emailing andrewATmasteringintensivecare.com.

LITFL Clinical education resources

Last update: Jul 18, 2017 @ 7:29 pm

Mastering Intensive Care 010 with Imogen Mitchell
Andrew Davies

Hemopurifier Filters Ebola, Hep C, Metastatic Melanoma: Interview with James A. Joyce, CEO of Aethlon Medical

Filtering infectious pathogens and cancer cells directly from whole blood has been an almost fantastic proposition, but the Hemopurifier from Aethlon Medical does just that. We’ve been covering it for over 10 years on Medgadget as it proves itself in clinical trials and new applications for it are discovered. It has already been studied as a treatment option for hepatitis Cmetastatic melanoma, and the Ebola virus. Recently at the 2017 BIO International Convention in San Diego, virus capture data was presented from a study of the Hemopurifier involving health-compromised patients infected with a virus.

We were offered and took an opportunity to ask James A. Joyce, Chairman and CEO of Aethlon Medical, about the technology within the Hemopurifier, its place in clinical care, and the future potential of the company.

Medgadget: Can you summarize for us how the Hemopurifier works and how the technology originated?

James A. Joyce: The Hemopurifier is a single-use disposable cartridge that we designed for use within the established infrastructure of dialysis machines and other blood circulatory instruments already located in hospitals and clinical worldwide.

From mechanism of action standpoint, the Hemopurifier converges the use of biocompatible plasma membrane technology with a plant-derived lectin known as galanthus nivalis agglutinin (GNA), which has an affinity to bind a broad-spectrum of infectious viruses, yet has limited interactions with human proteins that are essential for health.  In essence, we capture infectious viruses by their surface glycan shield, which is an evolutionary structure that viruses deploy to cloak themselves from being recognized by the host immune system.  As a result, we are able to eliminate circulating infectious viruses before they are able to infect new cells or organs.  For average size person, the entire circulatory system can pass through the Hemopurifier about once every 20 minutes.


Medgadget: What is the experience for the patient like? Is it much like hemodialysis? How long does a treatment session last?

James A. Joyce: To date, Hemopurifier therapy has been administered to virally infected individuals for periods of four to six and one-half hours.  Unless patient is extremely ill, they are able to read or watch TV during which treatment is being administered and do so in a relaxed environment.


Medgadget: Although primarily intended to capture viruses, it has been studied for preventing the spread of metastatic melanoma. What is the status of that and do you expect the device to be applicable to other cancers?

James A. Joyce: We are quite proud of our cancer research as more than a decade ago, we began patenting our belief that tumor-derived exosomes played a significant role in cancer progression and much like infectious viruses, these targets had an immune-evasion surface structure similar to viruses that would allow us to capture them with our Hemopurifier.  At the time however, the consensus of the mainstream medical community consensus was that exosomes were nothing more that cellular debris and had no biological function.

As it turns out, our original belief was right!  Tumor-derived exosomes represent a significant unmet need in cancer care as they subvert the immune system of cancer patients and seed the creation and spread of metastasis, which is attributed to 90% of cancer deaths.  We have demonstrated that the affinity mechanism by which the Hemopurifier operates can capture tumor-derived exosomes associated with several forms of cancer, including breast, ovarian and metastatic melanoma.  Additionally, as a medical device, we believe the Hemopurifier can combine to augment the benefit of other cancer therapies without adding drug toxicity or interaction risks.


Medgadget: What about Ebola? Has the device been used on enough patients to determine its effectiveness?

James A. Joyce: The Hemopurifier was used in the successful treatment of a critically-ill Ebola-infected patient in Frankfurt, Germany.

At the Frankfurt University Hospital, a Ugandan physician, who was infected with Ebola in Sierra Leone where he was treating Ebola patients, was administered Hemopurifier therapy 12 days after being diagnosed.  At the time Hemopurifier therapy was initiated, the patient was comatose with multiple organ failure.

The patient’s viral load prior to the administration of a single 6.5-hour Hemopurifier treatment was reported to be 400,000 virus copies per milliliter of blood (copies/ml). Post-treatment viral load was measured at 1,000 copies/ml and never again rose above that level.  The treatment was well tolerated with no adverse events reported.   After completion of therapy, researchers at Phillips University in Marburg Germany were able to administer what is known as the Hemopurifier capture assay, which revealed that 242 million Ebola viruses were permanently captured by the Hemopurifier during treatment.  We achieved our mission to save lives, as the patient made a full recovery and was able to return home to his wife and children.

In regard to clinical study effectiveness, there is seldom the ability to demonstrate statistically significant effectiveness with Ebola and other virulent pathogens that don’t permit for controlled human clinical studies to be conducted.


Medgadget: Is Aethlon working on improving the device? Would it be appropriate to make different versions of the Hemopurifier that are indicated for different diseases?

James A. Joyce: Based on our proven broad-spectrum capabilities against viral pathogens, the current iteration of our Hemopurifier provides us many therapeutic “shots on goal”; especially when considering that only 9 of the approximately 300 viruses that are infectious to man are addressed with an approved antiviral drug. Additionally, our Hemopurifier provides an actual strategy to address previously unknown pathogens that emerge naturally through mother-nature or are created by man as agents of bioterrorism.  If we wanted to accelerate the rate of eliminating a life-threatening virus from circulation, we would likely consider the simultaneous administration of two Hemopurifiers.

In regard to other disease conditions, we have the ability to interchange the immobilized GNA within the Hemopurifier with an antibody or affinity molecule that is directed toward other disease conditions.  However, our focus today is to clinically advance our Hemopurifier as a broad-spectrum virus treatment countermeasure.


Medgadget: What disease targets are you looking to try the Hemopurifier on in the future?

James A. Joyce: Beyond our opportunity in infectious disease, we would like to initiate human studies of our device in those afflicted with cancer.


Medgadget: What about the future of your company? Can you share your goals and your intended direction?

James A. Joyce: We are working to establish the industry for affinity therapeutic devices to address unmet needs in global health, with an emphasis directed toward life-threatening conditions that are beyond the reach of traditional drug mechanism.  Our primary mission is simply to save lives.

Flashbacks: Hemopurifier FDA Approved to Filter Ebola Out of Blood in Clinical Study…Aethlon Hemopurifier Now Filtering Blood of Ebola Patient…Aethlon’s Hemopurifier Proven Effective Against Metastatic Melanoma…Hemopurifier to be Studied as Treatment Option for Hepatitis C…Hemopurifier to Treat Infectious Disease…

Product info page: Hemopurifier…