geoffrey modest medical blogs

​ The Lancet recently published a review of the global burden of disease from alcohol use from 1990 to 2016, a systematic analysis for the Global Burden of Disease Study 2016 (s ee  alcohol leading risk factor death globally lancet2018  in dropbox, or  doi.org/10.1016/ S0140-6736(18)31571-X ).  Funding Bill & Melinda Gates Foundation ​. Details: -- 694 data sources of individual and population-level alcohol consumption, including 28 million individuals and 649,000 registered cases of the respective outcomes, in 195 countries -- a standard drink was considered 10 g of pure ethyl alcohol -- as opposed to prior studies, they included:     -- estimates of tourist and unrecorded alcohol consumption (they used local published data to estimate consumption both from tourists as well as from illicit production, homebrewing, local beverages, or alcohol sold as nonalcohol products), though they acknowledge that this data might not be completely reflective of the drinking patterns    

2 articles: one on the lower incidence of cancer with organic foods. the other a CDC report on the quite high levels of fast food consumption in the US -------------------- A recent population-based prospective cohort study found that those eating more organic foods had a decreased overall risk of cancer (see  cancer risk dec with organic food jamaintmed2018  in dropbox, or doi:10.1001/jamainternmed.2018.4357​) Details: -- 68,946 participants provided information for 16 products, including the consumption frequency of labeled organic foods, from 2009 to 2016. Study done in France, assessing the large-scale French NutriNet-Sante cohort, a web-based prospective cohort study looking at the association between nutrition and health. -- 78% female, mean age at baseline 44 years -- those in the lowest quartile of organic food consumption include: people employed as manual workers, retired, or students; those with less than a high school diploma, those with lower monthly inc

​ A recent article found an increase in lung cancer in those on ACEIs (see  htn  ace-i  inc  lung ca bmj2018  in dropbox, or  doi.org/10.1136/bmj.k4209 ). Details: --992,061 patients, newly treated with antihypertensive drugs from 1995-2015 and followed  til  end of 2016, from the UK Clinical Practice Research Datalink --mean age 56, 46% male, 7% alcohol related disorders, 22% current smokers/23% past smokers/48% never smokers, BMI <25 in 31%/25-30 in 31% />30 in 23%, mean duration of htn treatment 1.5 years, 17% on statins --335,135 patients were treated with ACEIs, 29,008 with angiotensin receptor blockers (ARBs), and 101,637 with both ACEIs and ARBs --ACEIs used: ramipril (26%; 257,420 patients), lisinopril (12%; 120;641 patients), and perindopril (7%; 70,955 patients). --those on ACEIs were more likely to be male, have alcohol-related disorders, be current smokers, have a higher BMI, more likely to be on statins and other meds --main outcome: incident lung

as perhaps a follow-up to the last blog on pelvic exams, there was a recent article in  Journal of Infectious Diseases looking at non-cephalosporin treatments for gonorrhea (see  gonorrhea noncephalosporin rx JID 2104 in dropbox,or  doi:  10.1093/cid/ciu521). this article is important because of the increasing resistance of gonorrhea to multiple agents over the past 50 years (eg, sulfa, penicillins, tetracyclines, cipro). at this time the only recommended treatment by the CDC is cephalosporins (eg, ceftriaxone, since there is too much resistance to cefixime), but there are reports of resistance to ceftriaxone, and it is unclear what to do if the patient has significant cephalosporin allergy. hence the importance of this study, where 401 patients (mean age 27, 35% MSM, and only 10% women, 60% black, 22% white, 9% HIV positive), from 5 sites across the US with uncomplicated GC aged 15-60 were randomly assigned to gentamicin 240 mg IM plus azithromycin 2 gm orally, or gemifloxacin (a 4th

A systematic review and meta-analysis found that postmenopausal bleeding preceded the vast majority of diagnoses of endometrial cancer, though only a small minority of women with postmenopausal bleeding in fact had cancer (see  postmenopausal bleeding review jamaintmed2018  in dropbox, or doi:10.1001/jamainternmed.2018.2820 ). Details: --21 studies were found between 1977-2017 that included the analysis of the prevalence of postmenopausal bleeding (PMB) in women with endometrial cancer: 3792 cases of cancer, 3257 of whom had PMB --92 studies were found to assess the risk of endometrial cancer in women with PMB: 31,220 women with PMB, 2611 of whom had cancer Results: --Prevalence of PMB in women with endometrial cancer     --overall prevalence of PMB was 90%     --similar % if limit study outliers, ie no difference in outcome if less variance between studies     --by tumor stage:         --in the 5 studies with stage I tumors (with 95% 5-yr survival): 94% had PMB

The CDC reported on the epidemiology of pertussis in the United States from 2000-2016, noting a significant increase in cases over time and suggesting that the acellular pertussis vaccine was suboptimally effective (see  pertussis epidemiol 2000-16 clininfdz2018 ,  or DOI: 10.1093/cid/ciy757 ) Details: -- this includes cases reported through the National Notifiable Diseases Surveillance System Results: -- 2000-16: 339,420 pertussis cases reported -- 88% white, 81% non-Hispanic, 10% hospitalized, 0.1% fatal -- age breakdown:     -- infants<1-year-old: 15.1% of cases, 75.3/100,000     -- kids 1 to 6 years old: 16.8% cases, 13.8/100,000     -- kids 7 to 10 years old: 15.0% of cases, 18.3/100,000     -- 11 to 18 years old: 27.7%, 16.3/100,000     -- 19 to 29 years old: 3.3%, 1.4/100,000     -- 30 to 64 years old: 19.7%, 2.8/100,000     -- >65 years old: 2.4%, 1.2/100,000 -- the proportion of cases in black and Hispanic persons was significantly high