geoffrey modest medical blogs

an intriguing article just came out from the Netherlands showing that Internet-based vestibular rehab works well for adults with chronic vestibular syndrome  (see vertigo online rehab bmj2019 in dropbox, or doi :  https://doi.org/10.1136/bmj.l5922 ) Details: -- 59 general practices recruited 322 adults >50yo with chronic vestibular syndrome that had been present for at least one month and was exacerbated or triggered by head movements -- mean age 67; 61% female; level of education 33% low/27% middle/40% high; 32% living alone; chronic diseases: 58% zero/31% one/10% more; time since vestibular diagnosis: 1 to 6 months in 16%/ 6 months to 2 years 29%/2 to 10 years 38%/>10 years 16%; associated psych conditions: 3% panic disorder/14% generalized anxiety disorder/6% major depressive disorder -- participants were divided into 3 groups:     -- stand-alone ventricular rehab (VR): internet-based intervention with weekly online sessions for 6 weeks and daily exercises for 10

A new article from last week's Am Heart Assn meetings found that treating LDL to a lower target led to fewer subsequent cardiovasc events in those with TIA/ischemic stroke (see  stroke LDL target nejm2019  in dropbox, or DOI: 10.1056/NEJMoa1910355) Details: --2860 patients with evidence of atherosclerotic disease, having had ischemic stroke in prior 3 months or TIA in the previous 15 days, were randomized to a target LDL of <70 mg/dL vs 90-110mg/dL, using adjustable doses of statins with ezetimibe as needed, in  the Treat Stroke to Target trial  from France (61 sites) and South Korea (16 sites)     -- ischemic stroke was defined as symptoms with documented    ischemic lesion on CT or MRI; TIAs had to be a motor deficit in one arm or leg, or speech disturbance >10 minutes     --all patients were screened with nonivasive imaging (carotid duplex, CT angiography, and MR angiography) per the AHA-ASA guidelines.  Also all got trans-esophageal echo or CT

a recent article tied testosterone therapy with increased risk of venous thromboembolism (VTE) in men, both those with and without hypogonadism ( testosterone and VTE jamaintmed2019 in dropbox, or doi:10.1001/jamainternmed.2019.5135 ) Details: -- 39,622 men with documented VTE , from the IBM MarketScan Commercial Claims and Encounter Database and the Medicare Supplemental Database, from 2011-2018. These databases contain claims information from US employers, health plans, hospitals, and Medicare -- these men had 12 months of continuous enrollment prior to VTE event, were followed at least 12 months, and were initially free of cancer at baseline -- mean age 57, 75% <65 years old, testosterone route: intramuscular 28%/transdermal 68% -- each man with VTE was matched with himself as his own control, assessing the times 6 months, 3 months, and one month prior to the VTE, and comparing that to similar time periods 6 months before each of  these, assessing the presenc

naloxone: IM vs nasal? You forwarded this message on Wed 11/20/2019 7:33 AM  You forwarded this message on Wed 11/20/2019 7:33 AM G      Geoff A. Modest, M.D. Wed 11/20/2019 7:31 AM Geoff A. Modest, M.D.  JAMA just published a potentially important article from Australia finding that intramuscular naloxone worked more rapidly and effectively than intranasal naloxone for opioid overdose (see  opioid OD naloxone IM vs nasal jamaopen2019  in dropbox, or  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2755306  ) Details: -- 197 patients were randomized to intranasal naloxone 800 µg plus IM placebo vs IM naloxone 800 µg plus intranasal placebo, in the Uniting Medically Supervised Injecting Center in Sydney, Australia, a supervised injecting site -- 88% male, mean age 34 -- 61% used heroin, 21% pharmaceutical opioids, 12% fentanyl, 5% methadone. 25% had conc