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Watch what you eat this week, as new studies show that some fish eaters have healthier brains post-mortem, while flavonoids – nutrients found in a host of fruits and vegetables – may help you maintain your belt size well into adulthood.
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Pick the brain of someone who eats fish, and you may find less Alzheimer's disease. Researchers looked at 286 autopsied brains and found that among APOE ε4 gene carriers – a population at very high risk for Alzheimer's – those who ate seafood at least once a week had less Alzheimer disease pathology than those that didn't. No significant impact was found for fish oil consumption. And while more fish means higher brain levels of mercury, mercury levels were not correlated with bad brain neuropathology. The population studied was old and white, so be careful when generalizing.
JAMA
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Researchers pooled three prospective cohorts to examine how self-reported flavonoid consumption affected weight change from 1986 – 2011. Increased consumption of most flavonoid subclasses was associated with self reported weight loss over four year time intervals after adjustment for other lifestyle factors. The antioxidants are found in red wine, apples, pears, berries, and peppers.
BMJ
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It’s not shocking that fish, fruits and vegetables seem good for you, even if you'd prefer to see prospective, randomized data. But you'll sound smart now, when you ask your residency to stop feeding you pizza three times a week. Informed.
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WHEN YOU'VE BEEN UP ALL NIGHT AND START MIXING UP PATIENTS
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Mixing viruses may be more helpful. Two new HIV vaccines insert modified HIV envelope proteins into strains of adenovirus. The vaccines were tested in humans and produced antibody mediated and T cell mediated immune responses against the HIV protein at 1 year. Good news, but still unknown is whether the vaccine prevents HIV, since the researchers only looked for blood borne evidence of immune response, and whether the immune response is durable beyond the timeframe studied.
Annals
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WHEN YOUR BUDDY TELLS YOU HE GAINED 15 POUNDS DURING INTERN YEAR
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Big is beautiful. But big mama babies don’t do as well in pregnancy. Obese women are more likely to have large, hard to deliver neonates, and they are at greater risk for gestational diabetes, the all-feared pre-eclampsia, and maternal weight gain. High-dose metformin, given from weeks 12-18 through delivery, did not change neonate birthweight. Still, the mommas gained less weight (about 4 pounds on average) and had lower rates of pre-eclamsia compared to placebo.
NEJM
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WHEN YOUR FRIENDS ASK YOU FOR HEALTH ADVICE, AND YOU'RE NOT QUITE SO SURE ABOUT YOUR RECOMMENDATION
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Better you than the WHO. In 1999 they recommended routine antibiotics for children with severe acute malnutrition. Researchers put the idea to the test in Niger, and found that amoxicillin did not improve nutritional recovery, though the amoxicillin children had a lower risk of transfer to inpatient care. Knocks on the study include concerns that the health care delivered in Niger was too good to be true for most global health settings.
NEJM
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WHEN IT'S WINTER, AND YOU'RE TRYING HARD TO SMELL SPRING
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Try dupilumab. When used in combination with an intranasal corticosteroid for chronic sinusitis with nasal polyps, the IL4 & IL13 inhibitor reduced polyp burden and improved quality of life. The drug has already been studied in asthma and eczema – members of the same inflammatory pathway as chronic sinusitis – so shared benefit comes as little surprise. Dupilumab also improved sense of smell. Great for those picking rose petals, not so good for the interns treating C. diff.
JAMA
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Watch for interstitial lung disease (ILD) in middle-aged patients with progressive shortness of breath. Listen for lung sounds that remind you of Rice Krispies, then focus on the history, which remains the most important diagnostic criterion. Abnormal lung imaging, usually high-resolution chest CT, supports the diagnosis. Imaging may suggest one of the many different types of ILD, and can potentially skip the need for lung biopsy. Reach for the bronchoscope if you need to exclude infection, sarcoidosis, and others.
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For transfusion goals in the ICU? The magic number is 7 g/dL of hemoglobin, according to TRICC, a large RCT from 1999 that found no mortality benefit in liberal (10 g/dL) versus restrictive (7 g/dL) transfusion strategies in critically ill patients. The patients who were repleted to 10 g/dL had significantly more cardiac events, including myocardial infarctions.
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Are out in all of their purple and gold glory. Notable changes this year include a longer recommended wait time between Prevnar and Pneumovax, new recs on serogroup B meningitis, and the addition of the new 9 valent HPV vaccine to the list of suitable HPV vaccines. Here's this year's adult immunization schedule by age and by medical indication.
Annals
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