geoffrey modest medical blogs

the NY Times had a couple of interesting articles recently: 1.  they had an opinion piece on the potential adverse effects of acetaminophen in pregnancy (see  http://www.nytimes.com/2016/09/25/opinion/sunday/the-trouble-with-tylenol-and-pregnancy.html  ), which was prompted by a recent article in JAMA Pediatrics (see  acetaminophen and pregnancy  jamapedi2016  in dropbox, or  doi:10.1001/jamapediatrics.2016.1775 ), but they also make  the following points  (I  added some of the scientific details and  provided  references to some relevant studies): --experiments show that acetaminophen impedes our ability to empathize (eg ,  see Mischkowski D. Soc Cogn Affect Neurosci .  2016; 11: 1345) --it suppresses the immune response after vaccination, eg with combo of pneumococcal and DTaP vaccines (see Prymula R. Lancer 2009; 374 (9698): 1339).  On e study found that in patients infected with rhinovirus, acetaminophen suppressed serum neutralizing antibody response and increased sympto

there was a recent systematic review/meta-analysis finding that in patients who have heart failure with reduced ejection fraction,  vigorous exercise training  ​significantly improved their quality of life (see  chf exercise training circ2016  in dropbox, or DOI: 10.1159/000448088).  details: --25 studies were included with 2385 participants (1223 exercising and 1162 controls) [of note, 8 of these studies had <30 patients, and 6 studies had >100] --They used the Minnesota living with heart failure total score (MLWHF), a 6-part inventory, all graded 0 to 5, assessing physical and emotional symptoms. A 5-point change is considered clinically meaningful. --they did not specifically define the different exercise groups, but an example of high-intensity is cycling 45 minutes at 90% peak work three days per week. An example of vigorous-intensity exercise was cycling for 30 minutes at 60-70% peak VO 2  three times a week. An example of moderate-intensity exercise was 15 minutes

An observational cohort study looked at patients on antiretroviral therapy (ART) for HIV, finding that some of the most effective yet cheapest regimens are not being recommended for use today ( see  hiv drug costs AIDS2016 ​ in dropbox, or Eaton EF. AIDS 2016; 30: 2215). I have included the 340b pharmacy pricing, which is the reduced federal pricing available since 1992 to eligible health care organizations ( mostly  Federally-funded clinics and public hospitals) vs the AWP, average wholesale price, used in private pharmacies. details: --491 patients (mean age 36, 83% men, 61% African-American) initiating anti-retroviral therapy (ART) between 2007-2013, at the University of Alabama at Birmingham --durability (time from regimen initiation to discontinuation), used as a surrogate for the combo of effectiveness and tolerability. --results for the 5 most common ART regimens used during that time:     --TDF/FTC (tenofovir disoproxil fumarate/emtricitabine) with efavirenz (atripla

The Agency for Healthcare Research and Quality (AHRQ) just released their clinical review comparing nonpharmacological vs pharmacological treatments for patients with major depressive disorders (see  https://www.effectivehealthcare.ahrq.gov/ehc/products/568/2155/major-depressive-disorder-report-151202.pdf ​ for the full report, or  https://www.effectivehealthcare.ahrq.gov/ehc/products/568/2303/major-depressive-disorder-clinician-160915.pdf  for the summary). details: --they reviewed 44 trials from 1990-2015 of patients with mild to severe major depressive disorder (MDD) --cognitive behavioral therapy (CBT) is as effective as second-generation antidepressants (SGAs, which for this review includes SSRIs, SNRIs, bupropion , mirtazapine, nefazodone, and trazodone) for mild to severe MDD, with moderate level of evidence. The evidence does not support SGAs plus CBT as being better than SGAs alone, though this was based on low quality of evidence --therapy (SGA vs CBT) was discontinued

a large Swedish population study found that  in diabetics with no previous cardiovascular disease,  there were progressively fewer cardiovascular events as the systolic blood pressure was lower  (see  dm   htn  no  cvd bmj2016  in  dropbox , or  doi.org/10.1136/bmj.i4070). details: --187,106 patients in the Swedish national diabetes register for at least 1 year, <= 75 yo, and no known cardiovascular disease (CVD), from 2006-2012 with mean followup of 5.0 years. From 861 primary care units and hospital outpatient clinics --most of the demographics got worse as the cohort in each 10-mm group of BP increased: median age was 55 in the lowest SBP group vs 64 in the highest; duration of diabetes 4.8 vs 6.8 years and the higher SBP group was more likely to be on more aggressive diabetes management;  LDL 2.8 vs 3.0 mmol/L but HDL 1.3 in all; more micro/macroalbuminuria in those with the highest SBP; and the mean number of BP meds was 0.7 in the SBP 110-19 cohort vs 1.1 in the 130-139