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You’ll never trace every last item in your diet to long-term health, but that hasn’t stopped the field from trying. New guidelines examine Big Macs and adverse outcomes.
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Nutrition research is by nature imprecise. So while new meds undergo gold-standard large RCTs, linking specific food groups to macro-outcomes often relies on observational studies and prospective cohorts. Red meat has been a favorite target for scrutiny: there are > 100 published studies on everything from chemicals in the blood after meat consumption to all-cause mortality, and much of the evidence – consider type 2 diabetes and premature death – trends towards harm. Just how harmful is open to interpretation.
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Links between red meat and adverse health outcomes lack strong supporting evidence, says an international panel of nutrition experts in a controversial set of newly-released guidelines. As part of a standardized review process, panelists found that a 'reasonable' red meat reduction (3 servings / wk of unprocessed red meat or 1 / wk of processed meat) would be unlikely to have a significant effect on cancer incidence or cardiometabolic outcomes and mortality. Environmental impact and animal welfare concerns were explicitly outside the scope of the review.
Annals
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A torrent of criticism claims the guidelines misinterpreted the evidence and are overly sensational. Some experts worry the widely discussed findings will be harmful to public and planetary health.
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When nights are over but you're still eating cereal at 9 pm
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ICU patients can have similar trouble getting back in the swing of things. A RTC of 640 high-risk (based on age and comorbidities) vent patients found that use of non-invasive (NIV) + high flow nasal oxygen (HFNO) following extubation reduced reintubation rates (12% vs 18%) compared to HFNO alone. Many centers already use NIV when extubating high risk patients, though this is the first trial to use HFNO in both treatment and control arms.
JAMA
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When 30% of your pages reference Tylenol
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Par for the course, but 30% of white patients have a gene mutation that renders clopidogrel ineffective. The POPular Genetics trial compared use of genotype-guided clopidogrel dosing with standard therapy with ticagrelor or prasugrel in 2,500 patients undergoing primary PCI. The genotype-guided approach significantly decreased bleeding compared to standard therapy (10% vs. 12%) and was noninferior in a composite outcome of net adverse events. Clopidogrel is generic (prasugrel and ticagrelor are not), and genotyping can be done with point-of-care testing.
NEJM
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When you're sick-pulled mid-glass
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Unpleasant surprises. DOUBT evaluated use of early brain MRI in 1,000 patients who presented with low-risk focal neuro symptoms (duration < 5 min or absence of speech or motor impairment). About 14% of patients were found to have acute stroke on imaging, and almost 30% of study patients had their final diagnosis reversed after MRI. At 1 year, an ischemic MRI was associated with a 6x increased risk of recurrent stroke, while absence of ischemic lesions conferred a > 99% negative predictive value against recurrence.
JAMA Neurol
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Add 1.75 million new hepatitis C infections each year to the 70 million infected persons worldwide. Twenty percent of patients are aware of their diagnosis, while only 15% of those with known disease have been treated with curative direct acting antiviral (DAA) therapy. Ten to 20% of patients with chronic infection will develop serious liver complications over 20 - 30 year follow-up. Mother-to-infant transmission occurs from 6% of monoinfected mothers, a number that rises to 11% with HIV co-infection.
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For the impact of DAA on long-term outcomes in hep C? A 2019 prospective cohort of 10,000 patients with chronic HCV infection found that after adjusting for baseline variables like fibrosis and MELD score, DAA-treatment was associated with decreased all-cause mortality (HR 0.48) and hepatocellular carcinoma (HR 0.66) but not decompensated cirrhosis over median follow up of 33 months. The study supports the general consensus that all patients with chronic infection should receive treatment.
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What your ID friends are talking about
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The New York State measles outbreak is over, says the CDC, and the agency expects the US to maintain measles elimination status going forward.
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We're off next week for Halloween and will return on November 8th. You can, if needed, wear scrubs as your costume. But please don't.
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