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January 15th, 2015

GUT WARS

THE STORY

There are more and more ways to use healthy human poop to cure recurrent C. difficile infection.

THE BASICS

C diff, diarrhea's El Chapo, prompts almost 500,000 yearly infections. Experts think the disease recurs so frequently because antibiotic-zapped gut flora can't prevent recolonization from new C diff spores. 

THE DEEP FREEZE

Fecal transplants re-populate gut flora with bacteria from healthy donors. But coordinating donors for fresh stool samples remains a major barrier to therapy. Turns out frozen fecal transplants were noninferior to fresh ones in eradicating recurrent C diff infections, which may make fecal enemas an option at more hospitals. You don't have to stop storing your Haagen Dazs in the GI suite freezer. But at least consider it.
JAMA

THE PILL

Fecal matter pills are now a real thing, and they may make stool transplant a lot easier. A recent GI conference abstract reported that a single dose of special capsules designed to release fecal matter into the gut cured C diff in a majority of patients. The capsules aren't yet approved for therapy, but Uncle FDA doesn't object to their sale because of the lack of other options in severe cases.

SAY IT ON ROUNDS

MORE FLAT TOPS, LESS CANCER

A cohort study analyzed late-mortality  defined as death 5 or more years after treatment  among childhood cancer patients treated from 1970-1999. The '90s kids were less likely to die from their initial cancer, less susceptible to long-term death from adverse treatment effects, and way more likely to have orange paratrooper pants than their '70s counterparts.
NEJM

WHEN YOU ARE TOO BUSY TO DRINK WATER DURING YOUR SHIFT

At least you're not drinking Pepsi. Self-reported frequent soda and sugary beverage drinkers were found to have more visceral adipose tissue – belly fat linked with insulin-resistance, heart disease, and stroke  than water or diet soda drinkers.
Circulation

IF YOU PLANNED YOUR NEXT VACATION IN RIO

The Zika virus has been spreading throughout South and Central America. It's transmitted via mosquito and causes a syndrome that is a lot like the flu. Public health officials worry that the virus is dangerous in pregnant women, as northeastern Brazil has seen an increase in newborn babies with microcephaly since the start of the epidemic. The virus said 'hi' to North America this week by making an appearance in Houston
Lancet

TEENAGE DREAM

Most adolescents who undergo bariatric surgery achieve long-term weight loss and see high remission rates for diabetes, hypertension, dyslipidemia, and renal insuficiency.  So far weight loss surgery in teens is felt to be safe, but the impact of micronutrient deficiency warrants long term follow up. 
NEJM

BRUSH UP

PRESCRIPTION OPIATES AND HEROIN

Heroin is increasingly cheap, and decreases in the price of heroin are linked to increased hospitalizations for overdose. But whether prescription opiate users are more likely to use heroin is controversial, and studies have so far failed to establish a clear link between opiate prescription patterns and rates of heroin use.

EBM: COURAGE UNDER FIRE

A decade ago, stents were given away as fast as Oprah’s favorite things at Christmas time. 2007's COURAGE trial brought this practice into question, concluding that people with stable angina did just as well with optimal medical therapy as with stenting. Stent patients did have some symptomatic relief, but no additional long-term health benefits were found. 

GET META

With proton pump inhibitors and chronic kidney disease. PPIs were associated with incident CKD in data extrapolated from two large population-based cohort studies. PPI users were more at risk for CKD than those on H2 blockers, and twice daily PPI users were at higher risk than those on once daily dosing.
JAMA

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