geoffrey modest medical blogs

The US Preventative Services Task Force (USPSTF) just released two recommendations concerning HIV infection, one on testing and one on the use of preexposure prophylaxis for the prevention of HIV Infections (PrEP). ----------------------------------------------------------- HIV screening (see  hiv screening uspstf jama2019  in dropbox, or doi:10.1001/jama.2019.2592): Recommendations : --" The USPSTF recommends that  clinicians screen for HIV infections in adolescents and adults aged 15 to 65. Younger adolescents and older adults who are at increased risk of infection should also be screened”, Grade A recommendation --“ The USPSTF recommends that  clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown”, Grade A recommendation Details  (will not go into much detail here): - - 1.1 million individuals in the US are currently living with HIV, m...

The American Diabetes Association (ADA) just updated their  diabetes "Standards of Medical Care" to incorporate results from the CREDENCE trial, which found that the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin was associated with decreased risk for both renal and cardiovascular failure events in patients with type 2 diabetes (DM2) and chronic kidney disease (CKD). see   http://www.diabetes.org/newsroom/press-releases/2019/updates-standards-medical-care-diabetes.html  , for their summary of the revisions, with links to the appropriate sections of the original document, conveniently with the updated materials highlighted in yellow. For my review of  the original 2019 full guidelines, see http://gmodestmedblogs.blogspot.com/2019/01/2019-diabetes-guidelines.html Details of update  (will focus on those with DM2): --urinary albumin excretion (eg spot urinary albumin/creat...

Another large study, this one from Korea, found that H pylori eradication was associated with reduced risk of gastric cancer (see  hpylori eradication gastric cancer dec gastroendosc2019  in dropbox, or doi.org/10.1016/j.gie.2019.04.232.) Details: -- 10,328 healthy subjects underwent EGD endoscopy and H pylori testing from 2003-2011, and had follow-up endoscopy and H pylori testing until 2013 -- mean age 49,  58%  men, BMI 24, current/past smoker 50%, current/past drinker 70%, fam history gastric cancer 14%, lipid lowering drugs 8%, atrophic gastritis 23%, total cholesterol 200/LDL 126/HDL 55 -- H pylori was detected using the rapid urease test or histologic test on EGD . Baseline H pylori detection rate was 54%     -- of note, of the 5061 patients with negative rapid urease test at baseline, 291 (5.7%) had H pylori on simultaneous histologic samples [ie, there are false n...

A recent article confirms several other studies suggesting that checking nonfasting lipid levels was as at least as good as getting fasting ones; this study compared results of fasting vs nonfasting from the same individual, looking at clinical outcomes (see  lipids nonfasting ASCOT jamaintmed2019 in dropbox, or doi:10.1001/jamainternmed.2019.0392). Details: -- posthoc perspective follow-up of 8270 participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA), comparing nonfasting and fasting lipid levels measured 4 weeks apart in each individual -- Includes both those with cardiovascular disease and those with no prior history -- 82% male, mean age 63, current smoker 35%, BMI 28, blood pressure 165/95, heart rate 71, fasting glucose 115, creatinine 1.1 -- prior stroke 12%, previous peripheral vascular disease 6%, diabetes 30%, family history of premature CHD 23%, aspirin 20% -- median follow-up 3.3...