By: Dr. Geoffrey Modest As a followup to my blog post on the CDC guidelines for sexually-transmitted diseases, there was a recent study looking at Mycoplasma genitalium resistance in the Netherlands (see doi:10.1093/jac/dkv136). And this comes right after the comment from prior my blog noting that M. genitalium “does respond to 1-g single dose of azithromycin (though resistance […]
Category: Archive
Primary Care Corner with Geoffrey Modest MD: Arthroscopic surgery for knee OA???
By: Dr. Geoffrey Modest There have been a couple of well-publicized studies finding that arthroscopic knee surgery for degenerative joint disease/osteoarthritis (OA) is not beneficial. However, there continues to be uncertainty, and “many specialists are convinced of the benefits of the procedure from their own experience”. In the US, 700K knee arthroscopies are done each year, […]
Primary Care Corner with Geoffrey Modest MD: Comparison of the 2013 ACC/AHA lipid guidelines to ATPIII
By: Dr. Geoffrey Modest A recent study assessed the accuracy of the 2013 ACC/AHA guidelines in identifying patients in the Framingham Study who either developed cardiovascular disease (CVD) and/or coronary artery calcification (CAC), comparing the results to that of the prior 2004 ATPIII guidelines. (see JAMA. 2015;314(2):134-141). Details: –2435 statin-naive participants (mean age 51.3, 56% female, mean Framingham Risk Score […]
Primary Care Corner with Geoffrey Modest MD: When to start meds in HIV patients
By: Dr. Geoffrey Modest A recent large multinational study (START trial: Strategic Timing of Antiretroviral Therapy) from 215 sites in 35 countries assessed the effect of randomizing patients with CD4 counts >500 to immediate antiretroviral therapy (ART) vs deferring therapy until the CD4 counts decreased to 350 or the development of AIDS or other condition requiring ART (eg pregnancy) […]
Primary Care Corner with Geoffrey Modest MD: Lung ultrasound to diagnose heart failure
By: Dr. Geoffrey Modest A potentially very useful multicenter study was just published finding that lung ultrasound (LUS) was better than chest xray (CXR) in the diagnosis of acute decompensated heart failure (ADHF) in patients presenting to the emergency room (ER) with dyspnea (see CHEST 2015; 148(1): 202 – 210). This is an increasingly common issue, with evidently very […]
Primary Care Corner with Geoffrey Modest MD: Antibiotic Overprescribing
Primary Care Corner with Geoffrey Modest MD: Antibiotic Overprescribing […]
Primary Care Corner with Geoffrey Modest MD: SSRI use in pregnancy and birth defects
By: Dr. Geoffrey Modest A recent case-control analysis from the National Center on Birth Defects compared women who had children with birth defects to those without, to assess the association of the birth defects with specific SSRIs (selective serotonin reuptake inhibitors) taken from the month before pregnancy and through the third month of pregnancy (see BMJ 2015;350:h3190). Details: –17952 mothers […]
Primary Care Corner with Geoffrey Modest MD: Marijuana passing through the generations…
By: Dr. Geoffrey Modest A pretty striking basic science article was recently published looking at the epigenetic effects of marijuana on rats, which seems to be inherited in the next generation (see doi:10.1038/npp.2015.155). There have been a slew of recent articles on marijuana suggesting that its adverse effects are more profound than many of us (myself included) […]
Primary Care Corner with Geoffrey Modest MD: NSAID warning by FDA
By: Dr. Geoffrey Modest The FDA recently reinforced their existing warning label on the use of non-aspirin NSAIDs and the increased chance of heart attack or stroke (this warning is already on the over-the-counter ones). Their comments: –the risk of heart attack or stroke can occur within the first weeks of taking NSAIDs –the risk […]
Primary Care Corner with Geoffrey Modest MD: Extended anticoag for PE
By: Dr. Geoffrey Modest JAMA published the PADIS-PE trial of patients having a first unprovoked pulmonary embolism (PE), randomized to stopping anticoagulation after 6 months vs continuing an additional 18 months (see JAMA. 2015;314(1):31-40). Details: –371 patients (mean age 58, 40% >65yo, 50% women, mean BMI 27, 45% with high bleeding risk per the Am College of Chest Physicians […]