geoffrey modest medical blogs

a recent systematic review and meta-analyses looked at a common problem: optimal blood pressure levels in diabetics (see  See  dm   htn goal bmj2016  in  dropbox , or  BMJ   2016;352:i717 ). this issue is clouded by the variability of results of several large studies and the variability of guideline recommendations by different societies and their changes over the past few years  (eg: Am Diabetic Assoc now  suggests goal of <140/90, though <130/80 "may be appropriate" if young, has albuminuria, or multiple cardiovasc risk factors; JNC8 suggests a goal of <140/90). these recommendations were based on published data; the current one systematic review includes previously unpublished data (eg, getting more granular data on the subset of patients with diabetes in larger trials, by contacting drug companies, authors, etc). this review also assessed both baseline blood pressure and achieved blood pressure on meds, and included only reasonably large studies (>100 patient

The Canadian Task Force on Preventive Health just published a provocative guideline on colorectal cancer(CRC)  screening in those not at high risk  (see  colonoscopy screening vs fit  cmaj2016 ​   DOI:10.1503  / cmaj.151125 ). details: --background:     ​--CRC is the 2nd most common cause of cancer-related death, with lifetime probability of 3.5% in men and 3.1% in women     --the incidence and mortality in both men and women increases dramatically in the 70-79 year age groups and continues to increase in the >80 year olds --recommendations:  -- adults aged 50-74 :         --screen those aged 50-59 using  gFOBT  or FIT (guaiac fecal occult blood test, or fecal immunochemical testing) every 2 years or flexible sigmoidoscopy every 10 years -- weak recommendation: moderate-quality evidence         --screen those 60-74 as with 50-59, but strong  recommendation: moderate-quality evidence         --do not screen adults > 75yo  -- weak recommendation: low-quality ev

a recent study from 4 EDs in Hong Kong looked at the relative efficacy of oral prednisolone vs indomethacin in the treatment of acute gout attacks (see  gout steroids aim2016 ​ in dropbox, or doi=10.7326/M14-2070 ​) . details: --416 adult patients (mean age 65, 75% male, mean duration of symptoms 2.8 days, mean pretreatment pain score using a visual analog scale VAS from 0-100 of 33mm at rest and 81mm with activity, 71% with recurrent gout, 83% with monoarthritis, lots of medical comorbidities, 43% with first MTP joint, 62% with knee, ankle, wrist, or elbow; tophi in 15%). gout was not confirmed by joint aspiration --randomized to indomethacin 50mg tid for 2 days, followed by 25mg tid for 3 days; vs prednisolone 30mg daily for 5 days. --results:     --no statistically significant difference between the meds either while in the ED at rest or with activity; or from days 1-14 afterwards         --while in the ED: the VAS decreased from about 30 mm to about 20mm at rest  and

A recent systematic review/meta-analysis looked at the effects of H pylori eradication and the incidence of gastric cancer ( see  hpylori rx and dec gastric ca gastro2016​  in dropbox, or  doi.org/10.1053/j.gastro.2016.01.02 8).  ​ details: --background:     --there are >720,000 deaths/yr from gastric cancer worldwide     --H pylori infection is the most important etiologic factor, infecting approximately 50% of the global population, and estimated to cause 78% of gastric cancers     ​--mechanistically, H pylori causes chronic gastric inflammation, leading to precancerous changes of atrophic gastritis, and also to gastric mucosal genetic instability through decreased acid secretion, "which can promote the growth of gastric microbiome that processes dietary components into carcinogens" --​ 24 studies, with a total of 715 incident gastric cancers among a total of 48,064 patients and 340,255 person-years of followup. almost all of the studies were from Korea, C