geoffrey modest medical blogs

​ The NY Times had a recent article on mumps outbreaks after waning mumps immunity post-vaccination https://www.nytimes.com/2018/03/21/well/live/mumps-is-on-the-rise-a-waning-vaccine-response-may-be-why.html )   , with reference to the study:  See  mumps immunity waning SciTransMed2018  in  dropbox , or  DOI: 10.1126/scitranslmed.aao5945) .  Details of the study: --reviewed specifics of several mumps outbreaks in immunized adults --data from 6 epidemiological studies of mumps vaccine effectiveness on the past decades in US and Europe --mathematical modeling done to assess whether this resurgence of mumps outbreaks was related to waning immunity after vaccination or whether new mumps strains emerged not covered by the vaccine Results: --immunity persists on average 27.4 years (16.7-51.1) after the receipt of any dose of the vaccine     --among 96.4% who were expected to get a p...

A recent data-mining study found a significant association between starting DPP-4 (dipeptidyl peptidase-4) inhibitors for diabetes and the later development of inflammatory bowel disease (see dm dpp4 and ibd bmj2018 in dropbox , or doi.org/10.1136/bmj.k872 . Details: --141,170 patients >18yo starting antidiabetic meds, from 2007-2016, and followed a median of 3.6 years. from the United Kingdom Clinical Practice Research Datalink of  >700 general practices .  --mean age 62, 15% with BMI >30, 15% alcohol-related disorders , 16% current smokers, 31% A1c>8% --primary outcome: adjusted hazard ratio for incident inflammatory bowel disease (IBD) with use of DPP-4 inhibitors vs other diabetes meds --30,488 (21.6%) received script for DPP-4 inhibitors; median duration of use =1.6 yrs --patients on DPP-4 inhibitors: older (66 vs 61yo),  more likely to have higher A1c concentration (A1c>8% in 44% vs 30%), longer du...

 ​The NY times had a health column highlighting the increases of obesity rates in young kids and adults (see  https://www.nytimes.com/2018/03/23/health/obesity-us-adults.html?module=WatchingPortal®ion=c-column-middle-span-region&pgType=Homepage&action=click&mediaId=thumb_square&state=standard&contentPlacement=7&version=internal&contentCollection=www.nytimes.com&contentId=https%3A%2F%2Fwww.nytimes.com%2F2018%2F03%2F23%2Fhealth%2Fobesity-us-adults.html&eventName=Watching-article-click  .  this was largely based on a recent article in JAMA ( see  obesity in kids increasing jama2018  in dropbox, or doi:10.1001/jama.2018.3060​). The more complete CDC report:  https://www.cdc.gov/nchs/products/databriefs/db288.htm ​  Details from the JAMA article: --obesity in youth had plateaued between 2005-6 and 2013-14, though had been  increasing  in adults --this current analysis is from the Nat...

Analysis from SPRINT confirmed that adding an additional antihypertensive drug to the regimen led to major decreases in blood pressure and cardiovascular events, despite some concerns that adding yet another drug had diminishing returns (see  htn more drugs help BMJ2017  in dropbox, or  doi.org/10.1136/bmj.j5542  ). Details: --SPRINT trial: 9361 patients with hypertension and high cardiovascular risk, mean age 66, racially diverse, BMI 30, NO diabetes or prior stroke, randomized to systolic BP of <120 vs <140 mmHg, achieving SBP of 121.4 vs 136.2 mmHg --the trial was stopped early because of clear benefit of intensive treatment, at median follow-up of 3.25 years --using data from this trial, researchers assessed the BP response and clinical effects of adding an additional BP medication in 9092 participants --at baseline: 9% of these patients were not on any BP med, 29% on 1 med, 35% on meds from 2 distinct classes, 26% from 3 or mor...