Among Doctors Blog - The Exclusive Physicians Network

Picks of the Week: Pokemon, the ice bucket challenge, and other frontiers in medicine

Posted on August 19, 2016 by Harris

From the employment of Pokémon GO! in public health to new advancements in tackling ALS and inducing partial recovery in paraplegic patients, there have been plenty of noteworthy news and evidence updates shared on the Among Doctors network. Let’s have a look at some of them:

Pokemon GO! Pandemic or Prescription? The Public Health Perspective
Pokémon GO! shows how an alternative way of thinking & and a new era of solutions are need to tackle old (or not-so-old) problems.
NEK1 variants confer susceptibility to amyotrophic lateral sclerosis
Two summers after the Ice Bucket Challenge, new research is crediting part of the $115 million raised to helping to identify NEK1 as a new ALS-related gene.
Long-Term Training with a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients
Following 12 months of training with this paradigm, all eight patients experienced neurological improvements in somatic sensation and regained voluntary motor control in key muscles.
Guideline Update on Duration of Dual Antiplatelet Therapy for CAD
This guideline-focused update on dual antiplatelet therapy for patients with coronary artery disease.
Pioglitazone Prevents Diabetes in Insulin-Resistant Patients With Cerebrovascular Disease
Pioglitazone is the first medication shown to prevent both progression to diabetes and major cardiovascular events as prespecified outcomes in a single trial.
Florida investigation links four recent Zika cases to local mosquito-borne virus transmission
The Centers for Disease Control and Prevention (CDC) has been informed by the State of Florida that Zika virus infections in four people were likely caused by bites of local Aedes aegypti mosquitoes.
Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis
People who achieve total physical activity levels several times higher than the current recommended minimum level of 600 METs/week (as recommended by the WHO) have a significant reduction in the risk of the five diseases studied.
Reasons for Trying E-cigarettes and Risk of Continued Use
Regulatory strategies such as increasing cost or prohibiting e-cigarette use in certain places may be important for preventing continued use in youth.

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Image credit: CC BY-SA 2.0 iphonedigital

Posted in Picks of the week ALS, breast cancer, cancer, coronary artery disease, diabetes mellitus, ice bucket challenge, ischemic heart disease, pokemon, public health, smoking, Zika, Zika virus

28th July: World Hepatitis Day

Posted on July 28, 2016 by Harris

On this year’s World Hepatitis Day, WHO calls for a rapid action to raise awareness of the disease, and increase access to testing and treatment services. Globally, 400 million people are affected by a viral hepatitis infection -a number that represents more than 10 times that of people infected with HIV. According to WHO, it is estimated that approximately 95% of people with chronic hepatitis are unaware of their infection, and less that 1% have access to treatment.

Moreover, WHO has recently published guidelines for the screening and treatment of people with hepatitis C infection, providing recommendations on the preferred regimens, and encouraging the employment of direct-acting antiviral combinations when appropriate.

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Posted in Clinical Highlights guidelines, hepatitis, WHO

Picks of the Week: New recommendations for HIV, fibromyalgia and more!

Posted on July 24, 2016 by Harris

Over the last days fellow colleagues shared articles, recommendations, and other noteworthy news on the Among Doctors network. Among them, there is also a very interesting blog post on Psychological And Mental Health by Professor Gabriel Ivbijaro (President of the World Federation for Mental Health and Chair of The World Dignity Project) that worths reading. Let’s have a look at the top picks of these news:

Migraine and risk of cardiovascular disease in women: prospective cohort study
Results of this large, prospective cohort study in women with more than 20 years of follow-up indicate a consistent link between migraine and cardiovascular disease events, including cardiovascular mortality.
EULAR revised recommendations for the management of fibromyalgia
Updated guidelines on fibromyalgia have been published by the European League Against Rheumatism (EULAR).
2016 Recommendations for Use of ARVs to Treat and Prevent Adult HIV Infection
Updated recommendations on the treatment and prevention of HIV infection, reflecting on the substantial advances of the ARVs, discussing the preexposure and post exposure prophylaxis, and considering the generics and their impact on pharmacoeconomics.
Effects of Pictorial Health Warnings on Smoking Cessation Attempts
Pictorial warnings effectively increased intentions to quit, forgoing cigarettes, quit attempts, and successfully quitting smoking over 4 weeks.
Association of Dietary Fats and Total and Cause-Specific Mortality
Dietary saturated and trans-fats were linked to increased rates of mortality. Replacing 5% of energy from saturated fats with equivalent energy from polyunsaturated fatty acid and MUFA was associated with estimated reductions in total mortality of 27%.
Making Psychological And Mental Health First Aid For All A Global Reality
The 2016 World Mental Health Day theme ‘Dignity in mental health – psychological and mental health first aid for all’ provides an opportunity for us to focus on an area that continues to provide challenges for people with mental ill health and their families, getting the right help in crisis.

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Photo credit: CC BY 2.0 by jonrawlinson

Posted in Picks of the week cardiovascular disease, dietary fats, fibromyalgia, HIV, mental health, migraine, mortality, smoking cessation

New recommendations on antiretroviral drugs for HIV infection

Posted on July 14, 2016 by Harris

The International Antiviral Society – USA Panel published their updated recommendations on antiretroviral drugs (ARVs) for the treatment and prevention of HIV infection. With more than 37 million people living with an HIV infection in the world, and 20 million not receiving an antiretroviral therapy, the new guidelines reiterate that all individuals diagnosed with the infection should initiate treatment as soon as possible, regardless of the CD4 cell count.

Moreover, the guidelines reflect on the substantial advances of the ARVs since the last recommendations were released in 2014, recommending initial regimens of two nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI) for most patients. Further points on preexposure and postexposure prophylaxis are discussed, as well as the pharmacoeconomics of the treatment, especially considering the introduction of less-expensive generic formulations.

In the accompanying editorial on JAMA, Kenneth Mayer and Douglas Krakower consider the guidelines a reflection of a successful 35-year research effort and argue that, “Historians may wonder whether the pace of discovery in the early days of the epidemic could have been accelerated, but no one can doubt the signal accomplishments of biobehavioral research and community engagement in forging a common strategy to deal with this global pandemic, one that continues to pose new challenges.”

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Posted in Clinical Highlights antiretroviral drugs, guidelines, HIV

Picks of the Week: Endometriosis, menopausal symptoms and more!

Posted on July 8, 2016 by Harris

More and more medical news are shared by fellow colleagues on the Among Doctors network on a daily basis. Here’s a selection of those the latest ones:

Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and meta-analysis
CA 125 performs well as a rule-in test facilitating expedited diagnosis and ensuring investigation and treatment can be confidently tailored for the management of endometriosis -however, a negative test is unable to rule out endometriosis.
Use of Plant-Based Therapies and Menopausal Symptoms: A Systematic Review and Meta-analysis
This meta-analysis of clinical trials suggests that composite and specific phytoestrogen supplementations were associated with modest reductions in the frequency of hot flashes and vaginal dryness but no significant reduction in night sweats.
Patient Navigation for Comprehensive Cancer Screening in High-Risk Patients Using a Population-Based Health Information Technology System
Patient navigation as part of a population-based IT system significantly increased screening rates for breast, cervical, and colorectal cancer in patients at high risk for nonadherence with testing. Integrating patient navigation into population health management activities for low-income and racial/ethnic minority patients might improve equity of cancer care.
Multimodal Randomized Functional MR Imaging of the Effects of Methylene Blue in the Human Brain
Using functional MRI, it was found that a single oral dose of methylene blue increased brain activity in the bilateral insular cortex, as well as the prefrontal cortex and parietal and occipital lobes, compared with placebo.
Hepatitis C Core Antigen Testing for Diagnosis of Hepatitis C Virus Infection
The HCVcAg assays with signal amplification have high sensitivity, high specificity, and good correlation with HCV RNA levels greater than 3000 IU/mL and have the potential to replace NAT in settings with high HCV prevalence.
Effect of Escitalopram on All-Cause Mortality and Hospitalization in Patients With Heart Failure and Depression
Chronic systolic heart failure patients treated for 18 months with escitalopram, an SSRI, did not demonstrate significantly reduced all-cause mortality.
Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults
There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches.

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Posted in Picks of the week endometriosis, escitalopram, heart failure, hepatitis C, menopause

Picks of the Week: The USPSTF advises on colorectal cancer and syphilis screening

Posted on June 28, 2016 by Harris

During the past weeks two important recommendations were published from the US Preventive Services Task Forse (USPSTF) on the screening for colorectal cancer and syphilis. Let’s have a look at them, alongside other news that our members shared in the Among Doctors community:

The US Preventive Services Task Force (USPSTF) published its recommendations on screening for colorectal cancer
The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation).
Screening for Syphilis: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
Screening HIV-positive men or MSM for syphilis every 3 months is associated with improved syphilis detection. Treponemal or nontreponemal tests are accurate screening tests but require confirmation.
Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial
Maternal exercise may be a preventative tool for hypertension and excessive GWG, and may control offspring size at birth while reducing comorbidities related to chronic disease risk.
Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage
The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139 mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg.
Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries
Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.
Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children
Current evidence does not support increasing the dose of ICS as part of a self initiated action plan to treat exacerbations in adults and children with mild to moderate asthma. Increased ICS dose is not associated with a statistically significant reduction in the odds of requiring rescue oral corticosteroids for the exacerbation, or of having adverse events, compared with a stable ICS dose.

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Posted in Picks of the week acute cerebral hemorrhage, asthma, blood pressure, chronic asthma, colorectal cancer, inhaled corticosteroids, pregnancy, screening, syphilis

Screen for colorectal cancer, urges USPSTF

Posted on June 19, 2016 by Harris

The US Preventive Services Task Force (USPSTF) recently published its recommendations on screening for colorectal cancer on JAMA, concluding that screening is beneficial in average-risk, asymptomatic adults starting at age 50 and continuing until age 75 years (A recommendation). In adults aged 76 to 85 years, the decision should take into consideration the health and history of the patient (C recommendation).

Screening for colorectal cancer can reduce mortality, whichever strategy is employed, says the USPSTF. Seven different screening approaches are included in the recommendations, despite their difference in effectiveness and potential harm: colonoscopy, fecal immunochemical testing for occult blood (FIT), multitargeted DNA stool test (FIT-DNA), guaiac-based fecal occult blood test, sigmoidoscopy, sigmoidoscopy with FIT, and CT colonography. The economic impact of such a screening is not addressed either.

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Image credit: Blausen Medical Communications, Inc. – Donated via OTRS, see ticket for details, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=27639260

Posted in Clinical Highlights colonoscopy, colorectal cancer, USPSTF

Unrestricted-calorie, high-vegetable-fat Mediterranean diet associated with no weight gain

Posted on June 7, 2016 by Harris

In a study published yesterday in The Lancet Diabetes & Endocrinology, Ramon Ostrich and colleagues reported on the Spanish PREvención con DIeta MEDiterránea (PREDIMED) randomized controlled trial and on the long-term weight change. In their five-year intervention, nearly 7500 asymptomatic men and women with type 2 diabetes mellitus or more than two cardiovascular risk factors were randomly assigned to receive either one of the two unrestricted-calorie Mediterranean diets (one supplemented with extra-virgin olive oil and one supplemented with nuts) or the control diet which included advice to reduce dietary fat.

The authors reported that although the dietary fat consumption was higher for the participants of the Mediterranean diets, in the five-years follow-up not only was there no weight gain, but they even noticed some evidence of decrease in the weight and waist circumference. The results of the study support the hypothesis that restricting calorie intake of healthy fats does not contribute to bodyweight maintenance.

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Posted in Clinical Highlights calorie intake, diet, mediterranean diet, type 2 diabetes, waist circumference, weight maintenance

Picks of the Week: Chronic insomnia, NSAIDs, opioids for low back pain and more!

Posted on June 4, 2016 by Harris

Besides the 69th World Health Assembly in Geneva that saw the release of many reports and news, this was a week of a plethora of other articles and evidence published worldwide. Fellow physicians selected the most important ones and shared them on the Among Doctors network:

Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline
The American College of Physicians recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder. (Grade: strong recommendation, moderate-quality evidence)
Comparative effectiveness and safety of strategies for preventing NSAID-associated gastrointestinal toxicity: Systematic Review & Metanalysis
The combination of selective COX-2 inhibitors plus PPIs provides the best gastrointestinal protection, followed by selective COX-2 inhibitors, and thirdly by nonselective NSAIDs plus PPIs.
Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: Systematic Review & Meta-analysis
For people with chronic low back pain who tolerate the medicine, opioid analgesics provide modest short-term pain relief but the effect is not likely to be clinically important within guideline recommended doses.
A Systematic Review With Meta-Analysis of Dual Bronchodilation With LAMA/LABA for the Treatment of Stable COPD
Dual bronchodilation is better than a LAMA or a LABA alone, regardless of the drugs used.
Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease
Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease.
World No Tobacco Day 2016
For this year’s World No Tobacco Day, the WHO are calling on countries to get ready for plain (standardized) packaging of tobacco products.
WHO releases report on Attacks on Health Care
Over the two-year period from January 2014 to December 2015, there were 594 reported attacks on health care that resulted in 959 deaths and 1561 injuries in 19 countries with emergencies.
Prevention of sexual transmission of Zika virus
An updated guide to inform the general public, and to be used by health care workers and policy makers to provide guidance on appropriate sexual practices in the context of Zika virus.

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Posted in Picks of the week COPD, emergencies, insomnia, low back pain, opioid, WHO, World No Tobacco Day, Zika, Zika virus

World No Tobacco Day 2016

Posted on May 28, 2016 by Harris

The World #NoTobacco Day is an annual awareness day organized by the World Health Organization (WHO) on 31st May, aiming at highlighting the health risks of tobacco use and prompting governments to take actions against smoking. According to the WHO, while tobacco use kills nearly 6 million people each year, approximately 1 country in 3 has minimal or no restrictions at all on tobacco advertising, promotion and sponsorship.

Over the last three years, the WHO has focused on the advertising ban, increased taxation and tackling the smuggling of tobacco products, all of which are actions based on evidence from epidemiological studies. This year, the World No Tobacco Day promotes the implementation of the standardized plain packaging of tobacco products.

Plain packaging is a proven measure that tackles consumption by making tobacco products less attractive to consumers, curbing the use of promotional material on the package, limiting misleading design techniques suggesting that some products are less harmful than others, and increasing the effectiveness of health warnings. The package should bear only the name of the brand and product name in standardized characters and dark colors.

The measure was first adopted in Australia in 2012, where early evidence suggests that it has begun to achieve its public health objectives. Since then plain packaging laws have been passed in France, Ireland and the United Kingdom, while several other countries are evaluating the implementation of such a measure.

Join the AmongDoctors physicians-only professional network and discuss with us different topics on smoking cessation, public health policies and evidence on tobacco use!

Posted in Clinical Highlights public health, smoking, smoking cessation, tobacco, WHO, World No Tobacco Day

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