geoffrey modest medical blogs

A recent systematic review and meta-analysis of cohort studies found that any alcohol consumption was associated with an increased risk of hypertension in men, though only higher consumption was associated with an increased risk in women (see  htn alcohol JAHA2018  in dropbox, or  DOI: 10.1161/JAHA.117.008202​ ). Details -- 20 reports from 18 international studies with 361,254 people (125,907 men and 235,347 women), and 90,160 incident cases of hypertension (32,426 men and 57,734 women) were included. -- Mean age at baseline in men range from 25 to 57 years, weighted mean of 47 and mean follow-up duration of 5.3 years; and women mean age range from 25 to 60 with a weighted mean of 47 and mean follow-up of 7.3 years -- most studies were adjusted for potential confounders -- Hypertension was defined as a systolic blood pressure >140 mmHg and a diastolic >90 mmHg. --  one alcohol drink was defined as 12 g of ethanol Results: -- in alcohol...

​MMWR just published an assessment of self-reported concussions from playing sports or being physically active in high school students in the US (see  https://www.cdc.gov/mmwr/volumes/67/wr/mm6724a3.htm?s_cid=mm6724a3_w  ) Details: --in an attempt to get better data, the CDC looked at the 2017 national US  Youth  Risk Behavior Survey (a bienneial, cross-sectional school-based survey, which now includes a question about concussion), since much of the medical data (eg from EDs) miss untreated concussions and much of the high-school athlete data miss concussions sustained outside of school-based sports --during the 12 months before the survey, the number of students with at least one concussion overall was  15.1% (which translates of about 2.5 million) , 13% among females and 17.1% in males. this decreased by grade (surprisingly to me , in reverse order: 17% grade 9; 15.2% grade 10; 15.3% grade 11; 12.2% grade 12 --simi...

There have been many concerns about the 2013 Am Heart Assn cardiovasc risk calculator tied to their new cholesterol management guidelines. Several investigators have found huge variations between predicted and actual cardiovascular events (see commentary below). A new article updated the risk calculator based on newer cohort data and revised the statistical methodology to produce a much more accurate risk calculator (see cad risk overestimate 2013 guidelines AIM2018 in dropbox, or doi:10.7326/M17-3011). Details: -- The 2 strategies tried were:     -- updating the database on which the risk calculators were based. The concept here is that several of the studies including the Framingham Heart Study original cohort began in 1948, and it seems appropriate to look at newer cohort data as a basis for the risk calculator (lots has changed since these earlier studies....)     ​-- different statistical methods: the concern ...

Because of some flaws in its original report, there was a retraction and re-analysis of the PREDIMED trial published first in 2013, where Spanish patients at high cardiovascular risk were randomized to 2 different Mediterranean diets vs control diet,  still finding a 30% decrease in cardiac events with the Mediterranean diet ( see cad prevention  medit  diet EVOO nejm2018  in dropbox, or DOI: 10.1056/NEJMoa1800389​). Details: --Multicenter Spanish trial with 7447 people aged 55-80 for men and 60-80 for women at high cardiovascular risk: diabetes type 2, or at least one of: smoking (>1 cigarette/d in last month), high LDL (≥ 160 mg/dl),  low HDL (<40 mg/dl), hypertension (SBP ≥140 or DBP ≥90, or on meds), overweight/obesity (BMI ≥25), or family history of premature CAD (definite MI or sudden death <55yo in father or 1st degree male relative, or <65 in mother or 1st degree female rel...

There are no compelling randomized controlled trials finding that adequate vitamin D levels are associated with reduced risk of colon cancer. However, a multitude of observational studies have confirmed this association, and a recent international pooling project of 17 cohorts reinforced its likely benefit (see  vit d and colon cancer jnci2018 in dropbox, or  doi : 10.1093/ jnci /djy087). Details: -- participant-level data from 17 cohorts analyzed, with 5706 colorectal cancer cases and 7107 controls -- these prospective court studies were from the United States (11), Europe (5), and Asia (1) -- 51% were women, 84% white. Median age was 60. Median time from blood draw to diagnosis of cancer was 5.5 years. -- Median circulating 25(OH)D levels in controls was 56 nmol/L (22 ng/mL): 54 nmol/L in women and 58 nmol/L in men -- seasonally-adjusted medians range from 27.6% lower to 41.9% higher than the original 25(OH)D checked Results: -- compared with 25(OH)D le...

​ A recent article suggested that tamsulosin was ineffective in improving kidney stone passage, for stones up to 9mm (see kidney stone tamsulosin not help jamaintmed in dropbox, or doi:10.1001/jamainternmed.2018.2259) Details: -- 497 patients with symptomatic urinary stones <9 mm in diameter , lodged in the ureter as demonstrated by CT scanning, were randomized to tamsulosin 0.4 mg vs placebo for 28 days, from 2012 to 2016 -- mean age 41, 27% female, 23% nonwhite, 30% personal history of kidney stones, 25% family history of kidney stones, 69% of the stones were in the distal ureter or ureterovesical junction -- stone size: 18% were 1-2 mm, 56% 3-4 mm, 21% 5-6 mm, 5% 7-8 mm (mean diameter 3.8 mm); hydronephrosis on CT in 74%, multiple stones in 38% -- primary outcome was stone passage based on CT visualization or capture by the study participant by day 28 Results: -- stone passage rates were 49.6% in the tamsulosin group vs 47.3% in the ...