geoffrey modest medical blogs

a recent mathematical modeling study based on Singapore suggested that quarantine, social/workplace distancing, and school closure were key to decreasing spread of SARS-CoV-2 (see  covid nonmed interventions singapore lancetinfdz2020  in dropbox, or  doi.org/10.1016/ S1473-3099(20)30162-6) Details: -- mathematical modeling was based on:     -- the FluTE influenza epidemic simulation model (accounts for demography, host movement, and social contact rates in workplaces, schools, and homes) to estimate the likelihood of human-to-human transmission of SARS-CoV-2 if local containment fails.     -- the geographical, demographic, and epidemiologic model of Singapore were used as the synthetic but realistic representation of the Singaporean population at the household and individual levels, using national 2010 census data     -- assumption that 7.5% of infections are asymptomatic (based on the flu data of 7.5%-22.7%), the mean inc...

there was a recent update of the CDC's "recommendations for HIV prevention with adults and adolescents with HIV in the United States" -- see  http://stacks.cdc.gov/view/cdc/26062 and you too can download the 240 page document...). the overall focus of this update  is to develop systems of care/infrastructure to facilitate improved access to and retention in care of HIV-positive patients. the underlying  issue is that recent studies have found that the vast majority of people with HIV are aware of their disease (around 85%, thanks to much more aggressive screening programs and, it seems to me, a broader acceptance of HIV in many communities), but only 2/3 are linked to care, 40% are retained in care, 1/3 prescribed antiretrovirals, and only 25% were effectively treated to suppress their HIV viral load (which has the dual benefit of, first, turning HIV infection from pretty much a death sentence into a chronic disease, and, second, vastl...

the Am College of Physicians just released a clinical practice guideline on interventions to prevent recurrent kidney stones (see  kidney stone secondary prevention AIM 2014 in dropbox, or  doi:10.7326/M13-2908 ​). background: --13% of men and 7% of women get kidney stones, and 35-50% have recurrence within 5 years without treatment --80% are calcium oxalate or calcium phosphate or both --dietary efforts include increasing water intake, reducing dietary oxalate, reducing dietary animal protein and other purines, and maintaining normal calcium intake results of this systematic review: --1 good quality and 28 fair-quality trials found insufficient evidence that assessing stone composition, or blood/urine chemistries reduces recurrences --80 fair-quality trials of dietary interventions have found that:          --increased fluid intake, reduced soft drink intake (esp soda acidified by phosphor...

The email/blog i sent out yesterday on the Mediterranean diet and diabetes prevention is a substudy of the larger PREDIMED study, and i forgot to mention that i had sent out another article on this study finding decreased development of cardiovascular disease with either of the Mediterranean diets (with extra--virgin olive oil or nuts) as compared to the low-fat diet.  this email/blog is as below.  geoff  Nejm with article on mediterranean diet in primary prevention (see  cad prevent mediterranean diet nejm 2013  in dropbox, or DOI: 10.1056/NEJMoa1200303), as follows:   --7500 spanish patients aged 55-80, 57% women, with high cardiovascular risk (type 2 dm, or at least 3 risk factors of smoking, htn, inc LDL, low HDL, overwt/obese, or fam hx premature cad) but no evident cardiac disease. Other baseline characteristics: 40% on statins, 20% on antiplatelet rx, 50% on ACE-i. pts assessed for primary outcome of major cardiovasc event rate (MI, stroke...

1. The US preventive service taskforce (USPSTF) just released their guidelines for BRCA testing (see  http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfinalrs.htm ). in brief, they suggest: --estimated prevalence of BRCA1 or 2  is 0.2% to 0.3% (ie, 1 in 300-500 women) in the general population of women , 6.0% in women with cancer onset before age 40 years , and 2.1% in the general population of Ashkenazi Jewish women . In a meta-analysis of studies in which recruitment was based on family history of breast or ovarian cancer,  BRCA1  mutation prevalence was 13.6%,  BRCA2  mutation prevalence was 7.9%, and prevalence of either mutation was 19.8% . --A woman's risk for breast cancer increases to 45% to 65% by age 70 years if there are clinically significant mutations in either BRCA gene . Mutations in the  BRCA1  gene increase ovarian cancer risk to 39% by age 70 years, and  BRCA2  mutations increase ovarian can...