geoffrey modest medical blogs

A recent systematic review and network meta-analysis found exercise and cognitive behavioral therapy were superior to meds in treating depression in patients with heart failure (see  depression in heart failure CBT jpsychres2019 in dropbox, or doi.org/10.1016/j.jpsychires.2018.10.007 Details:   -- 21 RCTs were identified with 4563 heart failure patients assessing depression treatment with exercise therapy (ET), cognitive behavioral therapy (CBT), or antidepressant medications (AD)     -- 1989 patients received an active intervention versus 1826 controls           -- 15 RCTs with 3309 patients compared ET with usual care           -- 4 RCTs with 390 patients compared CBT with usual care           -- 3 RCTs with 878 patients compared AD with placebo   -- mean age 63 years, 61% men. 47% from North America/43% Europe/5% from South America and Australia   -- median follow-up duration 3.5 months, with minimum of 1.5 months; median sample size 208 patients (studies ranging f

A study in Colorado found a dramatic increase in ED visits for cannabis-related problems, more so with edibles (s ee  marijuana edible ED visits AIM2019  in dropbox, or doi:10.7326/M18-2809 ). Details: -- Of 449,031 eligible visits in a large urban academic hospital in Colorado from 2012-2017, 9973 ED visits (2.2%) had ICD codes for cannabis use -- Of these 9973 ED visits,  2567 (25.7%) were at least partially attributable to cannabis:     -- 238 (9.3%) were related to edible cannabis     -- 2194 were related to inhalation Results: -- a random review of 4800 records confirmed the accuracy of ICD coding for cannabis exposure -- reasons for cannabis-attributable ED visits:     -- GI symptoms: 788 (30.7%), most commonly cannabinoid hyperemesis syndrome (301 patients)     -- intoxication: 762 (29.7%)     -- psychiatric symptoms: 633 (24.7%), such as acute anxiety or acute psychosis     -- chronic psychiatric conditions: 100 (15.8%), such as depression, schi

Analysis of US  National Health surveys found that even a few minutes of leisure-time physical activity was found to have mortality benefits (see  exercise low dose dec mortality BrJSportsMed2019 in dropbox, or doi:10.1136/bjsports-2018-099254). Details: -- 12 waves of the National Health Interview Surveys (1997-2008) were linked to the National Death Index records until 2012 -- 88,140 eligible participants aged 40-85 were included -- 79% were 40-59 yrs old/22% >59yo, 47% men, 77% white/9% black/10% Hispanic, 14% less than high school education/30% high school/56% more than high school, 9% married, BMI 18.5-25 in 41%/25-30 in 39%/>30 in 19%, never smokers 53%/former smokers 25%/current smokers 23%, lifetime alcohol abstainers 20%/former drinkers 16%/light-to-moderate drinkers 60%/heavy drinkers 5% -- after median follow-up of 9.0 yrs:     --7855 all-cause deaths     --1695 CVD-specific deaths     --2269 cancer-specific deaths Results: -- all of analyses

a study in England found that commercially available IGRAs (interferon- g  release assays, specific for M. tuberculosis) do not have sufficient accuracy for the diagnostic evaluation of suspected tuberculosis (see  tb igra not accurate lancetinfdz2019 in dropbox, or doi.org/10.1016/S1473-3099(18)30613-3). Details: -- 845 adults with suspected tuberculosis were prospectively followed for 6 to 12 months for the subsequent diagnosis of tuberculosis, comparing the accuracy of commercially available IGRAs -- patients greater than 16 years old were enrolled from 10 National Health Service hospitals in five English cities -- patients are classified as culture-confirmed tuberculosis, highly probable tuberculosis (clinical and radiologic features highly suggestive of TB and unlikely caused by other diseases), clinically indeterminate diagnoses, and those where active tuberculosis was excluded (mostly with a history of exposure to TB and a negative PPD screening test, defined as <1

A recent article found that one month of  rifapentine  plus  isoniazid  (INH) daily was  noninferior  to a nine-month INH course in patients with HIV and either latent tuberculosis infection (LTBI) or living in an ar ea with high TB prevalence  (see   tb   ltbi   hiv   inh   rifapentine  1 month nejm2019  in  dropbox , or DOI: 10.1056/NEJMoa1806808)       Details:   -- 3000 HIV-infected people living in areas of high TB prevalence (at least 60 cases per 100,000  population ) or having evidence of LTBI.  From 45 sites in 10 countries.   -- Randomized to open label  regimen of daily  rifapentine  (300mg a day for weight <35kg, 450mg per day for weight   35-45 kg, and 600mg a day for weight >45kg) plus INH 300mg plus pyridoxine for one month ;  vs  INH plus pyridoxine for 9 months   -- 54% women, median age 35, 52% from Africa/8% Asia/24% South America/16% North America, 66% black non-Hispanic/24% Hispanic/8% Asian or Pacific Islander,  BMI 23.5, median CD