geoffrey modest medical blogs

  a recent Scottish study found that patients with diabetes who develop stage 4 chronic kidney disease (CKD) and continue metformin had improved survival (see dm metformin with lower GFR AmJKidnDis2025  in dropbox, or doi: 10.1053/ j.ajkd.2024.08.012) Details : -- 371,742 Scottish residents with type 2 diabetes were evaluated from the Scottish Diabetes Research Network-National Diabetes Study, from 2010-2019 -- 4,287 prevalent metformin users were identified who had incident stage 4 CKD (ie, eGFR <30); 1,713 of them (40.1%) discontinued the metformin     -- patients who stopped the metformin did so within 6 months of reaching CKD stage 4; those who continued metformin did so for at least 6 months     --55% of those who continued the metformin did stop it in the follow-up period (about 60 patients/year from years 7-12, about 25/year from year 13 to end of study): 44% continued throughout the follow-up -- median age 77, 51% women...

  a recent meta-analysis found that using bright light therapy (BLT) as an adjunctive therapy is associated with decreased depression symptoms even in individuals without seasonal affective disorder (see depression bright light in nonseasonal JAMApsych2025  in dropbox, or doi:10.1001/jamapsychiatry.2024.2871). thanks to Talya Salant for bringing this to my attention.   Details : --11 unique randomized controlled trials were found from 2000-2024 with 858 patients assessing the effect on depression response with vs without added BLT     -- 7 of these studies were in patients with major depressive disorder: one study of patients with severe MDD, most others had patients with moderate or severe depression; 3 had patients with bipolar disorder, and 1 had both     -- intervention group: 9 studies exposed the intervention group to 10,000 lux bright light therapy (BLT) for 30-60 minutes, one study used 7000 lux, and 1 study 2...

  a recent randomized control trial found that in patients with stable coronary artery disease and atrial fibrillation (AF), monotherapy with the anticoagulant edoxaban was better than dual antithrombotic therapy with an added antiplatelet drug (see afib and stable CAD NEJM2024  in dropbox, or DOI: 10.1056/NEJMoa2407362)   Details : -- 1040 patients were enrolled in a multicenter, open-label, adjudicator-masked, randomized trial comparing edoxaban monotherapy with dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) in patients with atrial fibrillation and stable coronary artery disease, in 18 sites in South Korea, with recruitment from  2019-2022     -- coronary artery disease (CAD) was defined as being previously treated with revascularization or managed medically         -- stable CAD was defined as having had a percutaneous coronary intervention (PCI) or CABG at least 6 months before enrollment or an...

  a recent letter-to-the-editor documented a dramatic decrease in cervical cancer deaths in US women younger than 25 years old, over the time period of 1992-2021. This was likely attributable to the advent of the HPV vaccine (see dec cervical cancer mortality in young women JAMA2025  in dropbox, or doi:10.1001/jama.2024.22169)   Details : -- cervical cancer mortality trends were obtained from the National Center for Health Statistics -- main outcome: the changes in cervical cancer mortality from 1992 to 2021, with specific reference to women <25yo   Results : -- 398 cervical cancer deaths were reported from 1992-2021 in women <25yo -- between the 3-year cycle of 1992-94 to 2013-15, there was a largely linear gradual decline in the cervical cancer mortality, at a rate of 3.7%/year (-4.8% to -2.1%) -- the cervical cancer mortality rate then decreased from 2016-2021 at 15.2%/year (-21.9% to -7.8%), and with an overall 62% reduction (see grap...