geoffrey modest medical blogs

A nother study found that a high vegetable diet decreases systemic inflammation, this time a vegan diet (see diet vegan dec inflam JAHA2018 in dropbox, or DOI: 10.1161/JAHA.118.0113670.) Details: --100 people with coronary artery disease (angiographically-defined, with >50% lesion in an artery >2mm caliber),  in open-label EVADE CAD study (Effects of a Vegan Versus the American Heart Association-Recommended Diet in Coronary Artery Disease), from 2014-17 --61 yo, 85% male, 92% white/7% black, 55% smokers (5% current), 64% htn/32% dyslipidemia/30% diabetic/30% prior MI/91% prior coronary revascularization --94% on aspirin, 85% on  P2Y12 inhibitor (eg clopidogrel), 95% statin (57% on high-dose statin), 90% normal EF     --overall, those on vegan diet were somewhat older than those on the AHA diet  --groceries that conformed to these diets were provided to patients every week, along with either the Simply Vegan cookbook or the AHA low-fa...

A recent retrospective  analysis predicted superior clinical outcomes using the new and lower blood pressure guidelines in patients > 60 years old (see  htn new guidelines better htn2019  in dropbox, or DOI: 10.1161/HYPERTENSIONAHA.118.12291) Details: -- the study compared the predictive value of the 2017 American College Of Cardiology/American Heart Association (ACC/AHA) guidelines vs the 2017 American College of Physician/American Academy of Family Positions (ACP/AAFP)  guidelines for people >60yo     -- ACC/AHA guidelines (the more aggressive ones): begin blood pressure meds if SBP >140 mmHg or DBP >90 mmHg. Also, initiate meds if SBP 130 to 139 or DBP 80 to 89 in those at high cardiovascular risk (history of vascular disease, 10 year ASCVD risk >10%, diabetes, CKD, age >65 with SBP >130 mmHg. Treatment intensification is recommended to get a SBP <130 mmHg; also for a target DBP <80 mmHg in tho...

new recommendations were released on HIV care in pregnant women, and interventions to reduce perinatal HIV transmission (see  hiv prenatal recs 2019 in dropbox, or  https://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf  . the following is a brief description of those recommendations more useful in primary care, from this 366-page document. Note: this is not fundamentally different from the 2018 guidelines on HIV therapy:  http://gmodestmedblogs.blogspot.com/2018/07/new-hiv-treatment-guidelines.html  . please see this blog/document for more general HIV info S ummary of main points: --partners of pregnant women should be tested for HIV. in women trying to get pregnant and have an HIV-positive partner who has a sustained negative HIV viral load, best to have condomless sex limited to 2-3 days before and the day of ovulation, which has "effectively no risk of sexual HIV transmission to the partner without HIV" --early HIV testing in pre...

The Lancet recently published the 2018 report on climate change and health, a 36-page document (see  climate change and health. lancet2018  in dropbox, or doi.org/10.1016/ S0140-6736(18)32594-7). Details: -- they assessed 41 indicators across 5 domains: climate change impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; finance and economics; and public and political engagement -- this document included 27 leading academic institutions, the UN, and intergovernmental agencies from every continent climate change impacts, exposures, and vulnerability -- extremes of heat have steadily increased since 1990 in all regions, with  157 million more people  exposed to heat wave events in 2017 vs 2000.     -- Populations in Europe and the Eastern Mediterranean are particularly at risk with 42% and 43% of the populations older than 65 (the ...

the American Cancer Society published their 2019 report on cancer statistics, finding an overall major decrease in cancer deaths but that increasing socioeconomic disparities in cancer are widening, especially in the most preventable cancers (see  cancer statistics CA2019 in dropbox, or doi: 10.3322/caac.21551, or https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21551  ) Details: --cancer incidence data through 2015, compiled from:     --SEER program (Surveillance, Epidemiology, and End Results)     --National Program of Cancer Registries     --North American Association of Central Cancer Registries --mortality data through 2016  from:     --National Center for Health Statistics Results, with my embedded commentary: --2019 (projected results): 1,762,450 new cancer cases and 606,880 cancer deaths     --most common: colon 101K cases/51K deaths, lung...

Antimicrobial prophylaxis for 3 common urologic procedures: more than half had antibiotics overprescribed, according to the American Urological Association (AUA) guidelines of 2008 ( See  antibiotic overprescribing by urologists jama2019  in dropbox, or  doi:10.1001/jamanetworkopen.2018.6248 ) Details: -- the AUA guidelines recommend antimicrobial prophylaxis for most urologic procedures to be no more than 24 hours post procedure -- 375 patients from 5 geographically diverse Veterans Health Administration sites from across the United States, from January 2016 to July 2017. These records were manually reviewed for periprocedural or post procedural antimicrobial prescribing -- 98% male, mean age 64, 77% white -- additionally, 29,530 records were evaluated by administrative data through the VA system overall for antimicrobial prescribing practices -- urologic procedures assessed: transurethral resection of bladder tumor (TURBT), ...