geoffrey modest medical blogs

A large European registry study looked at the risk of teratogenic effects of 8 different antiepileptic meds (see seizure meds and congenital malf lancetneuro2018 in dropbox, or  doi.org/10.1016/S1474-4422(18)30107-8 ). Details: --the EURAP international registry, a longitudinal prospective registry collecting data on the outcomes of antiepileptic drugs used during pregnancy. established in 1999, involving 42 countries and more than 1500 collaborators --7355 pregnancies in the registry, involving exposure to one of 8 antiepileptic drugs --maternal age 30, duration of pregnancy at enrollment 8 weeks, parent history of major congenital malformations 1%, European 87%, parity 0 in 59%/1 in 32%/2 in 7%/3 or more 2%, idiopathic epilepsy 39%/localization-related 50%,  tonic-clonic seizure in first trimester in 7%, folic acid intake 38% appropriate/61% inappropriate, female child 49% --primary objective: compare the risk of major congenital anomalies assessed at 1 year after

​​ A large Spanish study confirmed the importance of 24-hour ambulatory blood pressure monitoring (ABPM) as a superior predictor of all-cause and cardiovascular mortality (see  htn   ambulat  higher mortality nejm2018  in dropbox, or DOI: 10.1056/NEJMoa1712231). Details: --63,920 Spanish adults in the ongoing Spanish Ambulatory Blood Pressure Registry, from 223 primary care centers within the Spanish National Health System; all enrolled in the registry from 2004-2010 --58% male, BMI 29, current smoker 16%, diabetes 20%, dyslipidemia 42%; prior  cardiovasc  disease 11% --clinic BP 147.9/86.7, 24-hr ABPM 129.2/76.5, daytime ABPM 132.3/79.4, nighttime ABPM 120.2/68.4 --clinic and 24h ABPM were examined, in the following categories (normal clinic BP is defined as <140/90, ABPM is <130/80):     --sustained hypertension (both clinic and ABPM were high)     --"white-coat" hypertension (elevated clinic but normal ABPM)     --masked hypertension (normal clinic

2. This is the second of 2 blogs on vitamin D and cancer, a randomized control trial of postmenopausal women treated with vitamin D and calcium, finding a nearly statistically significant benefit in preventing cancer (see  vit d and cancer older women jama2017  in dropbox, or doi:10.1001/jama.2017.2115). see  http://gmodestmedblogs.blogspot.com/2018/04/vitamin-d-and-cancer-risk-cohort-study.html for the first blog. Details: --2303 postmenopausal women, randomized to 2000 IU vit D3 plus 1500 mg calcium per day vs placebo for 4 years. 2064 (90%) completed the study. women were from 31 rural counties in Nebraska --mean age 65,  BMI 30, 99.5% white, 35% surgical menopause, 6% current smokers/67% never smokers, 15% estrogen therapy --baseline 25(OH)D level 32.8 ng/ml [pretty high at baseline, being already vitamin D replete by the guidelines!!!], baseline median calcium supplement 600 mg/d, vitamin D 720 IU/d, dietary calcium 640 mg/d, dietary vitamin D 105 IU/d; --primary ou

​ 2 recent articles assessed the effect of vitamin D and cancer risk, both suggesting some benefit: one  a prospective observational study and the other an interventional one. 1. A long-term Japanese prospective study found a decreased overall cancer risk with increasing vitamin D levels (see  vit d and cancer japan bmj2018  in dropbox, or  doi.org/10.1136/bmj.k671 ) Details: --nested case-cohort study within the Japan Public Health Center-based Prospective Study cohort, a study in 9 public health centers across Japan, started in 1990 and expanded in 1993, with 140,420 participants --mean age 54, 36% male, BMI 24, 18% physical activity >1x/week,  72 %  never smoker / 9% <20 pack-yrs/12% 20-40 pack-yrs/7% >40 pack - yrs, 62% never drinker/9% occasional / 13% <150g per wk/8% 150-300gm/8% >300g, 4% diabetes, 21% fam history of cancer, 16% supplemental vitamins     ​--there were some impressive differences in the groups: cancer cases were somewhat older (56 vs 54),

​Studies have suggested that  the Relaxation Response (RR) lowers blood pressure hypertensive patients. A new article assesses the potential mechanism, suggesting that relaxation-related effects on the innate immune system may well be associated with the antihypertensive effects of relaxation (see  http://www.wbur.org/commonhealth/2018/04/06/harvard-study-relax-genes   ; for article: see   bp genetic resp to relaxation jaltcompmed2018 in dropbox , or DOI: 10.1089/acm.2017.0053​​). Details: --8-week intervention on 24 non-medicated patients with BP 140-159/90-104, defined rigorously  as 3 weekly run-in visits: after patient seated at rest for 5 minutes, 3 BP measurements were taken at least 2 min apart, and if SBP varied >8mmHg, continue checking until values within this range, then average them --baseline: 56 yo , HTN duration 5 yrs , 71% female, 50% married, 83% white, 75% employed, 63% completed college --baseline BP: 143.7/90.9 --patients then had 8 weekly

​ A new US Health and Human Services report recommended a new single-pill alternative as initial therapy in adults with HIV, a  combination of  bictegravir / emtricitabine / tenofovir   alafenamide  (BIC/TAF/FTC ) , giving it an A1 recommendation  ​ (see  https://aidsinfo.nih.gov/news/2044/adult-arv-panel-classifies-bic-taf-ftc-as-recommended-initial-regimen-for-hiv  ). Details: --2 large drug company-sponsored RCTs confirmed non-inferiority of  BIC/TAF/FTC :     -- one confirmed non-inferiority of the single drug combination BIC/TAF/FTC as compared to  dolutegravir  (DTG) plus TAF/FTC (see  https://www.ncbi.nlm.nih.gov/pubmed/28867499  ), finding at week 48, 89% on  BIC/TAF/FTC  had HIV RNA <50 copies/ml, vs 93% on DTG /TAF/FTC         --similar adverse events in both groups: 2% in BIC/TAF/FTC discontinued therapy vs <1% on  DTG/TAF/FTC (no individual adverse event happened in more than 1 person), though overall drug-related adverse events were less common on BIC/TAF/