geoffrey modest medical blogs

John Bernardo MD sent me the following, in response to my blog this week on CDC guidelines for LTBI treatment. John is a local expert on TB as a well-regarded national one (has been on some CDC study groups regarding LTBI detection/treatment), and is a great clinician (and person). His reference to 3HP is to the weekly inh/rifapentine therapy for 3 months (see http://gmodestmedblogs.blogspot.com/2018/07/updated-ltbi-treatment-with-weekly-meds.html for my first blog on 3HP, as well as the mmwr on it, which has the references john alludes to).  And, he did give me permission to share this, along with its source…  geoff I would be a bit careful with the 3HP regimen. -          It really has been studied only in recently infected people – most over 16 y/o – early in the infection process.  So extrapolating effectiveness, especially by “noninferiority” to 9 mos INH, to all populations with LTBI may be a stretch. -          Side effect of hypotension, near syncope, syncope is a

The CDC just published the 2020 vaccination schecdule for kids: see  https://pediatrics.aappublications.org/content/early/2020/01/31/peds.2019-3995  , or  https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fschedules%2Fhcp%2Fchild-adolescent.html  ) Most of the changes since 2019 are only clarifications included in their footnotes, as follows (will not include just formatting changes): --DTaP: dose 5 is not necessary if dose 4 was administered at age 4 or older and was administered at least 6 months after dose 3 -- Tdap: an option to use this for booster doses, as well as any remaining doses for catch up series     -- children age 7 to 9: if they receive a Tdap or a DTaP, they should receive routine Tdap at ages 11 to 12     -- children aged 10-18: if they receive a Tdap at age 10, no need for booster at age 11-12; if they received DTaP, this counts as the adolescent Tdap booster -- H. influenza

The CDC just published new recommendations regarding treatment for latent TB infections (LTBI), highlighting shorter and less toxic regimens, see  https://www.cdc.gov/mmwr/volumes/69/rr/rr6901a1.htm  . Recommendations : --shorter course (3-4 month) rifamycin-based treatment regimens are preferred over longer isoniazid (INH) monotherapy-based ones (6-9 months) --preferred regimens:     --weekly INH plus rifapentine for 3 months, for those >2 yo (and including those HIV-positive, though check for drug-drug interactions:  https://www.hiv-druginteractions.org/checker  is a great website, or go to  https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-opportunistic-infection/0  for an updated listing of drug interactions). adult dose INH 900mg and rifapentine 900 mg once a week     --daily rifampin for 4 months. adult dose 600mg daily     --daily INH plus rifampin for 3 months. adult dose INH 300mg and RIF 600mg daily --alternative regimens:     --INH for 6 m

the Alcohol Abuse and Alcoholism (NIAAA) division of NIH just released their analysis of US death certificates, finding almost 1 million people died from alcohol-related causes between 1999-2017, with the number of deaths more than doubling from 1999 to 2017 (see  https://www.nih.gov/news-events/news-releases/alcohol-related-deaths-increasing-united-states  ). For relevant article see  alcohol deaths doubling alc clin exp rsch2019  in dropbox, or  DOI: 10.1111/acer.14239 Details: -- number and rate of alcohol-related deaths by age, sex, race, and ethnicity between 1999 - 2017 for people >16yo from the US National Center for Health Statistics, by death certificates -- deaths were considered to be alcohol-related if alcohol was listed as either an underlying or contributing cause (up to 20 multiple or contributing causes were indicated on the death certificates)     -- acute alcohol-related causes of death included acute behavioral disorders, finding of alcohol in bloo

A recent summary article reviewed both placebo and nocebo effects, reflecting  respectively   increases in beneficial or harmful results (s ee  placebo nocebo review nejm2020  in   dropbox , or DOI: 10.1056/NEJMra1907805 ). These placebo/nocebo effects occur in clinical trials (specifically comparing an active agent with placebo), informing patients about medical treatments, and public health campaigns Details: -- placebo effects can be associated with the release of various hormones including endogenous opioids, endocannabinoids, dopamine, oxytocin, and vasopressin.      -- these effects seem to be specific: for example the placebo effect in patients with Parkinson’s disease seems to b e specific to dopamine release, though dopamine release is not associated with placebo effects on acute or chronic pain       -- patients subjected to experimental pain had benefit from the potent opioid remifentanil; but those patients who thought incorrectly that the remifentanil had been s