iStock_000056753446_MediumKudos to creative scientists this week on PodMed, as Rick and I highlight a study in Science taking a look at the benefits of measles vaccination in preventing other infections and deaths!  In a complex paper working with the knowledge that folks who've had measles infection experience a period of immunosupression, rendering them susceptible to a host of other infectious diseases, these investigators decided to examine death data for children aged 1 to 9 in Europe and 1 to 14 in the United States before and after mass measles vaccination campaigns were undertaken.  Lo and behold, preventing the immunosuppression relative to measles infection did decrease deaths due to other infectious disease.  The authors propose that the well-known fact that measles vaccination has reduced child mortality in resource-poor regions of the world by 30-50% can be explained by this mechanism.  Rick and I take the stance that this is yet one more reason for parents to take a look at the facts and make sure their children are vaccinated, both for their own benefit and for all of us.  We agree with the authors' sentiment that measles vaccination is one of the greatest public health triumphs ever undertaken.

Other topics this week include incentivizing smoking cessation in NEJM, and two from JAMA Internal Medicine: dangers of different forms of testosterone supplements, and sonography of the arm for blood clot detection.  Until next week, y'all live well.

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iStock_000021002106_FullClostridium difficile, or C. dif, as it is abbreviated in medical parlance, is well-known to healthcare providers, infecting many patients and killing some, especially older folks who are hospitalized or people who are immunocompromised.  How best to manage this mostly hospital-acquired or nosocomial infection has been a subject of active research for years, since antibiotic treatment isn't always successful and reinfection or recrudescence is common.  Enter now spore transplant, as Rick and I discuss on PodMed this week, and as described in a JAMA paper.  The strategy follows on the heels of fecal transplant, first attempted with fresh stool introduced through the rectum, then via swallowed capsules.  These researchers reasoned that introduction of a strain of Clostridium that doesn't produce toxins could result in colonization of the colon such that the toxigenic strain couldn't get a foothold.  Lo and behold, that's exactly what happened with oral administration of capsules containing spores of the non-toxin forming organism.  And as I opine in the podcast, there's also substantially less 'yuck factor' with this treatment.  Phase III, anyone?

Other topics this week include cardiovascular risk factors for adolescents in low and middle income countries, in the Lancet, a lariat device for atrial fibrillation in JAMA Internal Medicine, and digoxin and mortality in the European Heart Journal.  Until next week, y'all live well.

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iStock_000021763916_LargeInappropriate use of prescription opioid medications is permeating all segments of society, and now, sadly, is impacting newborns, as Rick and I discuss on PodMed this week.  'Neonatal abstinence syndrome,' where neonates may manifest a host of symptoms such as irritability, rigid muscles, instability in blood pressure, and even seizures, secondary to mom's opioid use, has increased markedly over the last 15 years, with this analysis of neonatal ICU admissions from 2004 to 2013 and published in the New England Journal of Medicine painting an even more dismal picture.

While previous reports had cited a three-fold increase in the incidence of neonatal abstinence syndrome from 2000 to 2009, this analysis finds an almost four-fold increase, with almost 20% of all NICU days nationally devoted to caring for these infants in 2013. Clearly, greater education of clinicians as well as pregnant women and those contemplating pregnancy is indicated, as well as research in how best to manage the condition, especially with regard to medications used in this population.

Other topics this week include a new vaccine for herpes zoster, also in NEJM, benefits of early and complete HPV vaccination in Pediatrics, and a lack of benefit seen with inferior vena cava filters in JAMA.  Until next week, y'all live well.

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iStock_000012940072_LargeType 1 diabetes is no fun for anyone, and it's especially problematic because it most often afflicts the young, who then must endure a lifetime of management strategies, all too often unsuccessful and increasingly onerous.  So if you're a parent of one child with type 1 diabetes, you'd unquestionably like to avoid the disease in subsequent children, known to be at risk.  Now, as Rick and I discuss on PodMed this week, that may be possible by actually using insulin as an immunogenic agent. That's as reported in JAMA.  Wow! we say.  What a novel and unique approach to the problem, for which we offer kudos.

Researchers identified 25 children who were at risk to develop type 1 diabetes based on family history and genotype, who were randomized to oral insulin of varying doses or not over a 3 to 18 month period.  Children were followed up to assess their immune response to insulin exposure with an eye toward inducing tolerance.  More profound T-cell responses were seen with the highest dose of insulin, and no hypoglycemia events occurred.  The investigators are moving forward into a phase 3 trial, so good news potentially for children at risk.

Other topics this week include another in JAMA, autism and vaccination (!).  One from NEJM- sequelae of Ebola virus infection, and in Neurology, guidelines on the management of first time seizure in adults.  Until next week, y'all live well.

 

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iStock_000022542067_sizedCataract surgery seems to be almost a rite of passage among elderly people in the United States, with the procedure itself complicated by the sometimes endless round of preoperative evaluations and procedures some ophthalmologists require, even though a Johns Hopkins study done over 10 years ago clearly establishes both the safety of the procedure and the lack of benefit seen with additional testing preoperatively.  Now, as Rick and I discuss on PodMed this week, a study in the New England Journal of Medicine reiterates these facts and adds more to the the body of evidence.

Researchers took a random sample of 500,000 Medicare beneficiaries who had cataract surgery in 2011 and identified preoperative tests they underwent.  The results reveal an astonishing 53% had at least one preoperative test, with both costs relative to the testing and subsequent physician follow-up in the millions of dollars.  Even more revealing was the identification of a cohort of ophthalmologists who were ordering the overwhelming majority of preoperative testing, causing me to quip to Rick that perhaps now that we know who's doing it, just like the opioid prescribing docs in Florida, we can target interventions to get them to stop. In any case, Rick feels strongly that persons who are planning cataract surgery should cite safety statistics of a less than 1% rate of complications and just say no to preoperative testing.

Other topics this week include a look at gestational diabetes and offspring autism risk, and mechanical versus tissue valves for mitral valve replacement, both in JAMA, and back to NEJM for a novel target for lowering cholesterol.  Until next week, y'all live well.

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iStock_000012458973_LargeWhen it comes to heart health, taller is better, a study in this week's New England Journal of Medicine confirms, at least as far as coronary artery disease goes.  And as Rick and I discuss on PodMed this week, as tall people we're happy to hear it!  But a closer look at the study also reveals that the authors use 'genetic variants,' aka, single nucleotide polymorphisms or SNPs, already known to be associated with height or with coronary artery disease to define the association. That's a novel approach that may prove quite useful in nailing down other long-observed but not proven associations. It may prove fruitful in generating ideas on possible mechanisms whereby coronary artery disease risk and height are linked as well.  As I opine to Rick, of course, the study doesn't provide a target for intervention or lifestyle modification to reduce risk, so is somewhat limited in terms of practicability, but gets the gee whiz prize for this week.

Other topics include 2 studies on exercise intensity and mortality in JAMA Internal Medicine, sudden cardiac death and exercise in Circulation, and open versus microsurgical laminectomy in the BMJ along with surgery versus physical therapy in Annals of Internal Medicine.  Until next week, y'all live well.

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iStock_000016849937_LargeBrunis edwardii, as Rick reveals on PodMed this week, is more commonly known as the 'teddy bear,' and at least one of this species resides in the majority of households in the US.  Therefore, it is important to be familiar with conditions and diseases that may impact the bears, he opines, along with hearty wishes for a happy April Fool's Day!  Exact reference to this paper, published in 1972, found below.

On a somewhat more serious note, we also discuss whether an apple a day really keeps the doctor away, as published in JAMA Internal Medicine based on NHANES data.  And two more rigorous studies are also discussed: use of acetaminophen for low back pain, hip and knee osteoarthritis from the BMJ, and encouraging results from an Ebola vaccine candidate published in NEJM.  Until next week, y'all live well.

Some observations on the diseases of Brunus edwardii (Species nova)

DK Blackmore, DG Owen, CM Young

Veterinary Record 1972;90:14 382-385doi:10.1136/vr.90.14.3

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iStock_000022176290_MediumWho wouldn't want a chef to prepare their meals?  As Rick and I discuss on PodMed this week, I most certainly would, and I'm in agreement with denizens of public schools, who made healthy changes to their dietary choices when a chef got involved  in food preparation.  That's according to a study in JAMA Pediatrics, where a couple of thousand kids enrolled in 14 urban school districts were the beneficiaries of chef-inspired school lunches for a period of three months, or not. After this time period, an additional variable called 'food architecture' was also introduced, where strategic placement of food items to encourage purchase and consumption was attempted.  Lo and behold, after 7 months consumption of vegetables increased quite a bit, with the chef being the winning variable. Rick and I were both tickled to observe that the chef needed to be on board for a while before the students, and even teachers and administrators, adopted the new menu.

Other topics this week include treatment for macular edema and diabetic retinopathy in NEJM, stents versus medical therapy for prevention of recurrent stroke in JAMA, and exercise, vitamin D and falls in elderly women in JAMA Internal Medicine.  Until next week, y'all live well.

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iStock_000021636699_LargeIf you have blocked blood vessels in your heart, should you have them opened with stent placement or undergo coronary artery bypass grafting, abbreviated CABG, a much more lengthy and complicated process but which previous study has shown has more durable results than stent placement?  On PodMed this week, Rick and I examine that question again based on results of two studies in the New England Journal of Medicine with so-called 'second generation' drug-eluting stents that purportedly resist blockage formation and the need for additional procedures. Results indicate that there are risks and benefits to both treatments, with Rick of the opinion that these studies will assist caregivers and patients to make informed choices based on their personal preference, while I opine that the quest for the perfect stent continues.  No doubt there will be plenty more on this subject.

Other topics this week include cardiac screening in low risk patients in Annals of Internal Medicine, breast biopsy results in JAMA, and imaging for low back pain in older folks in the same journal.  Until next week, y'all live well.

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iStock_000017052299_LargeWhen an adult breaks a bone, 5 to 6% of the time it's the upper arm bone known as the humerus. Now a study in JAMA Rick and I discuss on PodMed this week shows that despite increasingly popular surgical management of the fracture, the good old-fashioned sling works just as well.  And that's in a group of people in whom the bone pieces are not in alignment, known as displacement, where the a priori hypothesis would be that getting those halves back in alignment would result in better outcomes.  Not so, by a variety of measures.  Including, perhaps most importantly, the patient's own assessment of treatment.

Other topics this week include liberal versus restrictive use of transfusions in patients undergoing cardiovascular surgery in NEJM, back to JAMA for transaortic valve replacement outcomes, and to JAMA Internal Medicine for the benefits of vegetarian diets on colorectal cancer risk.  Until next week, y'all live well.

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