geoffrey modest medical blogs

colorectal cancer is increasingly being diagnosed in adults <50 yo (ie, prior to the time of recommended screening by USPSTF), with projections that by the year 2030, 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in this younger group.  A recent population-based cohort study, looked at the disease stage at presentation, treatment patterns by stage, and cancer-specific survival (see  colon ca in younger pts cancer2015  in dropbox, or DOI: 10.1002/cncr.29716) ​. the study was supported by the Agency for Healthcare Research and Quality. details: --the researchers accessed the large SEER database (Surveillance, Epidemiology, and End Results), a source for cancer incidence, survival and prevalence, which captures 28% of the US population and is geographically, racially and ethnically diverse. They looked at all patients 20-79yo diagnosed with histologically confirmed colon or rectal cancer between 1998-2012 --results:     --258,024 individuals with documented

the Am College of Physicians just released an "advice for high-value care" regarding the assessment and workup of hematuria ( see  hematuria workup annals2015   in dropbox, or doi:10.7326/M15-1496​) ​. their points: --though there are no recommendations to support performing hematuria screening (the USPSTF gives it an "I", or insufficient evidence, rating), millions of patients get routine urine dipsticks and microscopic exams (though many of these tests may be done for other reasons as well, given the multitude of evaluations on a single dipstick). but 44-77% of primary care physicians have been endorsing the use of urinalysis in routine practice, though the % is decreasing over time. --any episode of gross hematuria deserves more urologic attention, since the pretest probability of cancer or a clinically significant condition is high (>10-25%), vs asymptomatic microscopic hematuria--AMH (0.5-5.0%, but up to 20% in high-risk groups), though the prevalence

a not infrequent question in primary care is when to stop bisphosphonates (BPs) for women with osteoporosis. there was a recent guideline on this subject from a task force of the American Society for Bone and Mineral Research (see  DOI: 10.1002/jbmr.2708, as well as  10.1056/nejmp1202619 for the 2012 response by the FDA). details of their recommendations: --background:     --osteoporotic fractures are really common (they quote the stark but i suspect inaccurate frequency of 1 fracture every 3 seconds around the world...), with substantial morbidity and mortality     ​--1 in 3 women and 1 in 5 men experience a fragility fracture after age 50     ​--3-4 year studies confirm that BPs work in decreasing the risk of vertebral (40-70%), hip (20-50%) and nonvertebral (15-39%) fractures     --lots of people take them: from 2005-9, 150 million scripts were dispensed in the US     ​--but, non so shockingly, these drugs are not benign, with reports of jaw osteonecrosis (esp in

Zika virus G Geoff A. Modest, M.D.     Reply all | Wed 1/27/2016, 12:51 PM Geoff A. Modest, M.D. You forwarded this message on 2/5/2016 11:08 AM The Zika virus has made the headlines of late. some details: --Zika virus is a mosquito-born flavivirus, mostly transmitted by Aedes aegypti mosquitoes (which also seem proficient in transmitting dengue, chikungunya and yellow fever viruses) --Zika infections have been documented through intrauterine as well as intrapartum transmission from a viremic mother. RNA from the virus is also detected in breast milk though transmission has not been documented by breastfeeding --80% of people are asymptomatic with the virus --when symptomatic, there are usually only mild symptoms, with acute onset of fever, maculopapular rash, arthralgia, nonpurulent conjunctivitis. lasting several days to 1 week. fatalities are rare. but Guillan-Barre

a not infrequent question in primary care is when to stop bisphosphonates (BPs) for women with osteoporosis. there was a recent guideline on this subject from a task force of the American Society for Bone and Mineral Research (see  osteop bisph length amsocbonersch2015  in dropbox, or DOI: 10.1002/jbmr.2708, as well as  osteop bisph length fda nejm 2012 , or 10.1056/nejmp1202619 for the 2012 response by the FDA). details of their recommendations: --background:     --osteoporotic fractures are really common (they quote the stark but i suspect inaccurate frequency of 1 fracture every 3 seconds around the world...), with substantial morbidity and mortality     ​--1 in 3 women and 1 in 5 men experience a fragility fracture after age 50     ​--3-4 year studies confirm that BPs work in decreasing the risk of vertebral (40-70%), hip (20-50%) and nonvertebral (15-39%) fractures     --lots of people take them: from 2005-9, 150 million scripts were dispensed in the US     ​--but,

there was a recent op-ed in the NY Times by the psychiatrist Richard Friedman on phobias and medical therapy (see  http://www.nytimes.com/2016/01/24/opinion/sunday/a-drug-to-cure-fear.html?emc=edit_th_20160124&nl=todaysheadlines&nlid=67866768&_r=0  ). his points: --29% of Americans have some anxiety at some point in their lives --he cites a pretty remarkable study on using propranolol to block this anxiety, perhaps from blocking norepinephrine action (see article and review below) --he also raises the interesting contrary concern: stimulants (eg ritalin) can cause release of norepinephrine and could theoretically enhance fear/anxiety, or even PTSD in those exposed to trauma. he notes that soldiers exposed to stimulants did in fact have more PTSD in Iraq and Afghanistan, controlling for attention deficit disorder. ------ a small study was done looking at the effects of the b-blocker propranolol in inhibiting memory reconsolidation and decreasing the phobia (se