geoffrey modest medical blogs

A recent large VA study looked at antibiotic duration after surgery and its association with surgical site infections, kidney injury, and C. difficile infections (see antibiotics surg prophy adverse events jamasurg2019 in dropbox, or doi:10.1001/jamasurg.2019.0569) Details: -- multicenter, national Veterans Affairs health care system cohort study of patients who had cardiac, orthopedic total joint replacement, colorectal, and vascular procedures, from 2008-2013 -- 79,058 patients were included, 96% men, mean age 65, 78% white/14% black, diabetes 27%, active smokers 29%     -- 21,396 cardiac procedures     -- 38,675 orthopedic procedures     -- 10,810 colorectal procedures     -- 8177 vascular procedures --antibiotics:     -- beta-lactam: 69%     -- vancomycin: 25%     -- aminoglycoside: 2%     -- vancomycin plus aminoglycoside: 1% -- median duration of surgical prophylaxis: 18.5 hours after skin closure -- duration of anti-microbial prophylaxis was defi

Analysis from the Framingham Study showed that increasing amounts of light-intensity physical activity was associated with increasing MRI-measured total brain volume (s ee  exercise and brain volume jama2019 , or doi:  10.1001/jamanetworkopen.2019.2745) Details: -- 2354 participants from the third-generation and offspring groups of the Framingham Heart Study were involved, from 2016-2019. -- mean age 53, 54% women, 55% college degree/21% some college/23% high school degree, 6.5% current smokers, 31% stage II hypertension, 6% diabetes, 4% cardiovascular disease, -- median steps/day 7519, moderate-to-vigorous physical activity 20 minutes/day -- All patients agreed to wear an accelerometer, as well as having repeat brain MRI scans -- patients were stratified according to whether they met the US Department of Health and Human Services recommend physical activity guidelines of at least 150 minutes of moderate-to-vigorous physical activity (MVPA) per week. 47% of these Fram

A recent prospective cohort study in the UK found the more than 50% of patients on statins have less than the recommended 40% decrease in LDL levels, associated with more cardiac events  (see  statin suboptimal response heart2019  in dropbox, or d oi:10.1136/heartjnl-2018-314253 ). Details: -- 165,411 primary-care patients from the UK Clinical Practice Research Datalink who were initially free of clinical CAD and had at least one pre-statin and one post-statin treatment LDL levels, from 1990-2016 -- mean age 62 years, 49% women, baseline LDL 159 mg/dL, posttreatment LDL 101, BMI 29, blood pressure 143/83, alcohol “misuse” 0.7%, unknown smoking status 96%, social economic status well-distributed in their 5 strata, diabetes 83%, atrial fibrillation 3%, chronic kidney disease 3%, family history of CAD 11%, treated hypertension 26%, low potency statins 24%/medium 81%/high 5% -- they assessed the LDL reduction within 24 months of statin therapy, with the goal of <40% redu

The NY Times recently highlighted a very scary story of a fungus found in hospitals that is not only resistant to all meds but also to the usual antiseptic hospital procedures ( see https://www.nytimes.com/2019/04/06/health/drug-resistant-candida-auris.html?smid=nytcore-ios-share  ) .   Details:   --the case was an elderly man admitted to Mt Sinai Hospital in Brooklyn for abdominal surgery, who contracted Candi da  auris , an in curable infection that led to his death 90 days later   --tests found the fungus everywhere in his room (including ceiling, walls, window shades, mattress, bed rails, doors, curtains, sink, phone, whiteboard, the IV poles, pump  …) and they “needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it”   --in the US,  the CDC has reported cases in New  York,  New Jersey, and Illinois, and noted this bug is an “urgent threat” . So far 587 cases have been reported, with 309 in New York (first case was in 2