geoffrey modest medical blogs

​  A recent systematic review and meta-analysis confirmed that smoking even one cigarette/d is really bad, with about ½ the attributable risk for cardiovascular disease as smoking 20 cigarettes/d (see  http://www.bmj.com/content/bmj/360/bmj.j5855.full.pdf  ). Details: -- 141 cohort studies in 55 publications were included Results: --men:      --coronary heart disease (CHD):  pooled relative risk  was 1.48 for smoking one cigarette per day and 2.04 for 20 cigarettes per day          -- but 1.74 and 2.27 among studies in which the relative risk had been adjusted for multiple confounders         --ie,  men smoking 1 cigarette/d had 46% of the excess CHD risk of smoking  compared to  ​20 cigarettes/d  (64%, if use the fulling adjusted risk)            ​--and, men smoking 5 cigarettes/d had 57% of the excess risk of smoking 20 cigarettes/d     --stroke: pooled relative risk​ was 1.25 for smoking one cigarette per day and 1.64 for 20 cigarettes per day         -- b

​(second of 2 blogs) a recent study found that influenza virus could spread just by exhaled breath (see  doi: 10.1073/pnas.1716561115  )​. Details: --355 symptomatic volunteers  with  acute respiratory illness in a college community, with 142 of 178 confirmed influenza infections in patients --in those with complete data: 50% male, 22% flu vaccination in current year, 15% vaccinated in current plus past year, asthma in 21%, 15% smokers, mean age 20, BMI 22.7, median coughs/30 min= 18, no sneezes, 8% systemic symptoms, 3% lower  resp  tract and 7% upper  resp  tract  sx --218 paired nasopharyngeal (NP) samples as well as 30-minute breath samples on days 1-3 after symptom onset, with the breath samples divided into coarse (>5  m m) vs fine (<=5  m m) particles Results: --infectious influenza virus was recoverable from:     --89% of the NP swabs, with 8.2x10 8  RNA copies and up to 10 5  infectious particles     --39% of the fine aerosols, with 3.8x10 4  RNA

​​ There have been several interesting studies recently on influenza, so will divide them into 2 days' worth of blogs. This flu season has been a pretty bad one, peaking earlier than usual, with widespread flu activity pretty much throughout the US, some novel strains of influenza A discovered, 37 pediatric deaths so far, and the proportion of deaths attributed to pneumonia and influenza increasing sharply to 9.1% in the week ending 1/6/18 (see  https://www.cdc.gov/flu/weekly/summary.htm ​ ) A recent Spanish case-control study found that older adults getting repeated flu vaccine had half as much severe influenza as compared to  nonsevere  infections (see  Casado  I. CMAJ 2018 January 8;190:E3-12)   Details: --130 with severe and 598 with  nonsevere  flu  admitted to 20 Spanish hospitals during the 2013/14 and 2014/15 influenza seasons  were matched with 333 and 1493 controls, respectively,  --all were community-dwelling and >65yo. All flu episodes were laborator

a recent article using modeling assessed the overall costs and benefits of different approaches for the treatment of opioid use disorder in California's publicly-funded treatment program s, finding large human and monetary benefits for a system with easy access to unlimited opiate agonist treatment  (see Krebs E. Ann Intern Med 2018; 168: 10). ​     Background: --California has some pretty unique circumstances:     --the largest number of persons with opiate use disorder ( OUD ) in the US     --California's regulations are quite restrictive: limiting the duration of medically managed withdrawal to 21 days, and requiring documentation of 2 or more failed treatments with medically managed withdrawal before opiate agonist therapy ( OAT ) can be started (methadone and buprenorphine)     --There are many exemptions from this regulation. but still the observation is that 54.3% begin therapy with medically managed withdrawal Details: --their model: 35-yo patients receivi

​ several articles came out recently on hepatitis C (HCV) treatment. A small study found equal efficacy of  pangenotypic   hep  c treatment in patients who are current injection drug users (see  doi.org/10.1016/S2468-1253(17)30404-1). Details: --103 patients enrolled in an open-label, single-arm study (SIMPLIFY study) with hepatitis C and continuing injection drug use (IDU) within the past 6 months, from 19 sites in 7 countries (Australia, Canada, New Zealand, Norway, Switzerland, UK, USA). All patients were naive to prior therapy. HIV-positive patients were excluded --median age 48, 28% female, 61% mild or no hepatic fibrosis (F0-1)/28% moderate to advanced fibrosis (F2-3)/9% had cirrhosis, genotype: 35% had 1/5% genotype 2/58% genotype 3/2% genotype 4, HCV viral load 6.1 log units, 59% on opioid substitution therapy (mostly methadone), 60% with some alcohol use in past 30 days/17% with "hazardous" alcohol use --74% injected in past month/26% at least daily in