geoffrey modest medical blogs

  The gut microbiome is hugely important in many aspects of human well-being. It is a major window through which our environment affects our threshold for developing a wide array of diseases. This blog will focus on some of the cardiovascular effects of a distorted (dysbiotic) microbiome.   -- a very recent article assessed the effects of the gut microbiome on cholesterol metabolism, specifically the microbiome's ability to convert cholesterol to coprostanol, a poorly absorbed sterol  (https://www.cell.com/action/showPdf?pii=S1931-3128%2820%2930295-X  ).  The researchers found that there was a clade of highly prevalent, but previously uncharacterized, IsmA-encoding bacterial species. This research group had previously found that the IsmA enzyme participated in converting cholesterol to coprostanol and identified uncultured  Eubacerium  species with the ismA gene; this conversion of cholesterol to coprostanol in patients, in 3 studies with paired s...

  One concern with many clinical studies is that their focus is too focused: eg, does this antibiotic cover a certain infection, and is it better than other antibiotics? However, there are broader concerns in general for drugs. Do they create the basis for other problems, perhaps even worse than the initial condition? A recent VA study found that doxycycline resulted in significantly fewer cases of Clostridioides difficile infection (AKA, Clostridium dificile of old, or just CDI) vs azithromycin: see  cdiff doxy better than azithro AmJInfControl2023  in dropbox, or     https://doi.org/10.1016/j.ajic.2023.09.007   Details : -- 156,107 hospitalized patients in the VA system were diagnosed with community - acquired pneumonia  (CAP)  in the   large  VA  database,  for this retrospective study of patients  f ro m 2009-2022         -- 87%  (135,703 patients)  received azithromyci...