geoffrey modest medical blogs

  a recent multicenter retrospective study conducted by several academic medical centers found that patients given an mRNA vaccine who had an immediate reaction to the first dose tolerated the second dose well (see  covid vaccine after immed rxn jama2021 in dropbox or doi:10.1001/jamainternmed.2021.3779 )   Details: -- 189 patients had an immediate allergic reaction to an mRNA vaccine, defined as symptom onset within four hours of the first dose, at least one allergic symptom, and referral for an allergy/immunology consultation assessment -- mean age 43, 86% women, 69% Moderna vaccine/31% Pfizer -- first dose reactions:     -- flushing or erythema: 53 people (28%)     -- dizziness or lightheadedness: 49 people (26%)     -- body tingling: 46 people (24%)     -- through tightness 41 people (22%)     -- hives: 39 people (21%)     -- wheezing or shortness of breath: 39 people (21%)     -- anaphylaxis: 17% (32 people) -- allergist skin testing performed in 80 peop

  A recent comparative study in diabetics found that tirzepatide, a dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist, outperformed the solo GLP-1 receptor agonist semaglutide both in diabetic control as well as weight loss (see  dm tirzepatide vs semaglutide NEJM2021  in dropbox, or DOI: 10.1056/NEJMoa2107519 )   Details: -- 1879 patients were randomized to tirzepatide at doses of 5 mg, 10 mg, or 15 mg; or semaglutide 1 mg -- mean age 57 years, 83% white/4% Black/70% Hispanic -- mean weight 94 kg, BMI 34 -- baseline mean A1c was 8.28%, 64% had A1c <8.5% -- eGFR 96, urine albumin-to-creatinine ratio <30 in 75%, blood pressure 131/79, 100% on metformin -- study was conducted in 128 sites in the US, Argentina, Australia, Brazil, Canada, Israel, Mexico, and the UK, from July 30, 2019 to February 15, 2021 -- tirzepatide was initiated as a 2.5 mg weekly and increased 2.5 mg every four weeks until the randomly assigned target was reached; semaglutide was init

  A recent VA study assessed mRNA vaccine effectiveness in veterans with cirrhosis (see  covid mRNA vaccine in cirrhosis jamaintmed2021  in dropbox, or doi:10.1001/jamainternmed.2021.4325 ).    Details:  -- mRNA vaccines were administered to 20,037 veterans (51% Moderna, 49% Pfizer), from Dec 18,2020 to March 17, 2021      -- 99.7% of those receiving a first dose who had a follow-up of least 42 days received a second dose  -- median age 69, 97% male, 45% age 60-70yo/43% 70-85yo, 61% white/23% Black/8% Latinx, 42% alcohol-associated cirrhosis, 77% overweight or obese, 52% diabetes, 39% current smoker/32% former  -- propensity matching for the control group (also 20,037 veterans as controls) to achieve similarity regarding age, sex, race or ethnicity, duration of follow-up, comorbidities, alcohol-associated liver disease, and severity of liver disease estimated by the Child-Turcotte-Pugh score  -- primary outcome: Covid-19 infections, documented by a positive PCR, 28 days after the dose